Intravitreal bevacizumab versus laser treatment in type 1 retinopathy of prematurity: report on fluorescein angiographic findings

Ophthalmology. 2014 Nov;121(11):2212-9. doi: 10.1016/j.ophtha.2014.05.015. Epub 2014 Jul 4.


Purpose: To compare the structural outcome at 9 months of eyes treated with intravitreal injection of bevacizumab with fellow eyes treated with conventional laser photoablation in zone I type 1 retinopathy of prematurity (ROP).

Design: Single randomized controlled trial.

Participants: All inborn babies with type 1 zone I ROP at a single institution were included in the study. One eye was randomized to receive an intravitreal injection of 0.5 mg bevacizumab; the fellow eye received conventional laser photoablation.

Methods: Digital fundus photographs and fluorescein angiography (FA) using the RetCam (Clarity Medical Systems Inc., Pleasanton, CA) were performed before treatment and 9 months after treatment.

Main outcome measures: Presence of retinal and choroidal abnormalities on FA at 9 months.

Results: Thirteen infants were enrolled; 1 died 3 months after birth. One laser-treated eye progressed to stage 5 retinal detachment. The remaining 23 eyes had favorable structural results at the 9-month follow-up and provided FA results. At 9 months of age, all eyes treated with a bevacizumab injection were noted to have abnormalities at the periphery (large avascular area, abnormal branching, shunt) or the posterior pole (hyperfluorescent lesion, absence of foveal avascular zone). These posterior and peripheral lesions were not observed in the majority of the lasered eyes.

Conclusions: This study documents significant vascular and macular abnormalities of eyes in the bevacizumab group. Long-lasting implications of these abnormalities for visual function of the child need to be studied.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Angiogenesis Inhibitors / adverse effects
  • Angiogenesis Inhibitors / therapeutic use*
  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Bevacizumab
  • Fluorescein Angiography
  • Gestational Age
  • Humans
  • Infant, Extremely Low Birth Weight
  • Infant, Newborn
  • Infant, Premature
  • Intravitreal Injections
  • Laser Coagulation*
  • Lasers, Solid-State / therapeutic use
  • Photography
  • Retinal Diseases / chemically induced
  • Retinal Diseases / diagnosis
  • Retinal Vessels / drug effects
  • Retinal Vessels / pathology
  • Retinopathy of Prematurity / diagnosis*
  • Retinopathy of Prematurity / drug therapy
  • Retinopathy of Prematurity / surgery
  • Retinopathy of Prematurity / therapy*
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors


  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • Bevacizumab