Dexamethasone Drops May Halt Retinopathy of Prematurity Progression

Traditionally, clinicians apply dexamethasone eye drops after performing laser ablation in infants with retinopathy of prematurity (ROP) in an effort to reduce the need for further treatment. Now, researchers are evaluating whether the glucocorticoid is effective preoperatively.

A Swedish study published in Ophthalmology Retina reviewed the technique’s application in premature infants born between 2016 and 2020. Investigators found that dexamethasone can avert progression of prethreshold type 2 ROP to type 1 ROP. Dexamethasone is thought to decrease several inflammatory mediators and subdue vascular endothelial growth factor (VEGF). Prior research has shown that inflammatory mediators impact the course of retinopathy, although no studies until the present analysis have explored steroid drops to treat type 2 ROP.

This study demonstrates a robust decrease in need for laser ablation once dexamethasone therapy was initiated for those with type 2 ROP, and thus “the results indicate that such eye drops can prevent these infants from developing type 1 ROP to a large extent,” the research explains.

Records for the region comprised 763 preterm infants born before 31 weeks of gestation between 2016 and 2019, as well as those born before 30 weeks of gestation in 2020 — according to new Swedish classification guidelines. Investigators focused on data of 48 infants who were diagnosed with type 2 ROP, evaluating treatment and the influence of co-variables: gestational age, sex, birth weight difference from the median expected for gestational age, and comorbidities.

Thirty-one of these young patients did not undergo dexamethasone treatment before laser surgery, although 17 received steroid eye drops upon type 2 ROP diagnosis — 16 of the 17 infants exhibited stage 3, zone 2; and one child had stage 2, zone 1. None displayed plus disease. Of those who underwent dexamethasone therapy, 13 (76%) did not need subsequent laser ablation, while 4 (24%) received laser surgery, odds ratio 0.11, 95% CI 0.03–0.43 (P =.001). Of all co-variables, including the comorbidities necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia, only bronchopulmonary dysplasia increased the odds ratio for laser ablation to 0.19, 95% CI 0.04–0.84 (P =.03).

For infants receiving eye drops, the median age to begin glucocorticoid treatment was 10.5 weeks after birth. Eye drops were started at 3 times per day, but subsequently reduced to begin with 2 times or once daily in a number of patients eventually treated. Median duration of therapy for individuals not requiring laser surgery was 28 days, but ranged from 14 to 98 days. Dexamethasone was tapered from every other day, until discontinuation. 

This study was limited by its retrospective nature, although data analyzed was from the interval where appropriate saturation levels stayed consistent. Alternately, a strength was the inclusion of all screened premature babies in a large region. “If treatment with steroid drops for infants with type 2 ROP can forestall type 1 ROP from developing and prevent blindness, this simple and low-cost treatment would make a monumental difference for those individuals,” according to the researchers.

Disclosures: Several of the study authors have declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.

Reference

Öhnell HM, Andreasson S, Gränse L. Dexamethasone eye-drops for treatment of retinopathy of prematurity. Ophthalmol Retina. Published online September 10, 2021. doi:10.1016/j.oret.2021.09.002