Observations of simultaneous aggressive anemia correction and intravitreal therapy for aggressive retinopathy of prematurity: A multimodal ROP assessment study (MROPAS) report number 2

Objective: To study the effect of simultaneous aggressive anemia correction and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) Bevacizumab, in aggressive retinopathy of prematurity (A-ROP) using multimodal imaging biomarkers. Methods: Non-contact ultra-widefield (NC-UWF) fundus imaging with integrated UWF-guided swept source optical coherence tomography (SS-OCT) was performed prospectively in preterm babies before and after intravitreal anti-VEGF (Bevacizumab) monotherapy. All babies with anemia, defined as a haemoglobin of less than 10.00 gm%, were advised to undergo blood transfusion with the neonatologist. The imaging outcomes of babies who were transfused (Group 1, 40 eyes of 20 babies) were compared to babies who did not undergo transfusion (Group 2, 40 eyes of 20 babies). Results: Group 1 eyes showed faster reduction of multilayered haemorrhages (p-value 0.030) and faster vascular progression to zone 3 (p-value 0.004). Group 2 A-ROP eyes had a higher incidence of reactivation (p-value 0.038), higher incidence of peripheral avascular retina (PAR) (p-value 0.044), and need for retreatment with laser (p-value 0.001) when compared to Group 1. Reduction in ischemic OCT biomarkers, like resolution of hyperreflectivity of inner retinal layers and improvement in choroidal thickness >250 microns, was better in Group 1 when compared to Group 2. Conclusion: Prompt correction of moderate to severe anemia with blood transfusion in anti-VEGF injected A-ROP eyes resulted in faster reduction of retinal haemorrhages and faster retinal vascular progression to the periphery. These eyes showed improved multimodal imaging biomarkers and a lower chance of reactivation or presence of PAR needing retreatment with laser.