Частота рецидивов ретинопатии недоношенных после введения ингибиторов ангиогенеза (афлиберцепта) в зависимости от массы тела ребенка

Abstract

Purpose. To study the effectiveness of treatment and the causes of reactivation of retinopathy (ROP) in premature children after aflibercept injection. Material and methods. This study was conducted at the V.F. Voino-Yasenetsky Scientific and Practical Center for Specialized Medical Care in Children from September 2021 to February 2023. The study included 122 premature infants (244 eyes) with ROP who received intravitreal administration of aflibercept. Patients were divided into two groups: the main group (reactivation group) consisted of children who received two or more intravitreal injections of VEGF inhibitors (aflibercept) and the control group consisted of children who received a single intravitreal injection of VEGF inhibitor (aflibercept) with a positive effect. In addition, 3 subgroups were identified depending on birth weight: 37 children had a birth weight of less than 900 g (1st subgroup), 41 children weighed from 900 to 1200 g (2nd subgroup), and 44 children weighed more than 1200 g (3rd subgroup). All patients were monitored for reactivation of ROP after intravitreal injection of aflibercept. Results. Since 2010, we have been using angiogenesis inhibitors in the treatment of ROP. The effectiveness of one dose of aflibercept (0,5 mg/0,0125 ml) is 84,84%. Repeated injections are easily tolerated by patients and increase the effectiveness of treatment to 99,76%. The work is devoted to the analysis of reactivation of ROP after one injection of aflibercept and the study of the reasons for repeated injections. 37/244 eyes (15,16%) showed reactivation of ROP after one injection. Factors influencing the reactivation of retinopathy of prematurity after intravitreal injection of aflibercept include: gestational age, postconceptual age at the 1st injection, birth weight, weight at the 1st injection, birth height, newborn head circumference, head circumference at the 1st injection, newborn chest circumference, history of blood transfusions, body mass index (BMI) at the 1st injection, nuchal cord complications. A large dependence of the reactivation rate on the child’s weight was noted. The birth weight subgroup of less than 900 g had a recurrence rate of 28,38%, followed by the average birth weight subgroup (12,20%) and the subgroup weighing more than 1200 g (6,82%). The reactivation time in the three subgroups of patients was 9,82±5,76, 10,20±3,27 and 12,33±9,24 weeks, respectively. The time of reactivation was also determined by the child’s weight. Reactivation occurred earlier in children with lower weight: in three subgroups of patients, 9.82±5.76, 10.20±3.27 and 12.33±9.24 weeks, respectively. Conclusion. Based on our research, the frequency of reactivation of ROP depends on the weight of the premature baby. A change in weight, even by 100 grams, changes the course of ROP. The lower the birth weight is, the higher the reactivation rate of ROP becomes. Reactivation of ROP occurs 4 times more often (in every 3–4 children) in children with very low birth weight (less than 900 g). The frequency of reactivation is also determined by the weight of the child during the first injection of an angiogenesis inhibitor. Weight also determines the time of reactivation, occurring in children weighing less than 900 or 9–10 weeks after the first injection. If there are risk factors, it is advisable to: carry out simultaneous injections in both eyes, which will increase the dose of aflibercept in total, carefully monitor them in the first 2 months with examination of the fundus, or increase the dose of the drug. Effectiveness can be enhanced by ingesting synergists or impact of physiotherapy. Key words: recurrence, reactivation, retinopathy of prematurity, risk factor, birth weight, intravitreal injection, aflibercept, vascular endothelial growth factor