Combination of intravitreal injection of ranibizumab and laser photocoagulation for the treatment of aggressive posterior retinopathy of prematurity

Abstract

Objective To observe the efficacy and safety of combination of intravitreal injection of ranibizumab and laser photocoagulation for the treatment of aggressive posterior retinopathy of prematurity (AP-ROP).Methods Medical records of 70 eyes of 35 premature infants with a primary diagnosis of AP-ROP in our clinic were reviewed and analyzed retrospectively.All the lesions were located in posterior zone,with 42 eyes in zone 1 and 28 eyes in zone 2.Forty-six eyes had iris neovascularization,while 19 eyes combined with vitreous hemorrhage.All participants underwent intravitreal injection of ranibizumab as the primary treatment within 12 hours after diagnosis of AP-ROP.The systemic and ocular adverse effects were observed.The change of retinal vascular tortuosity and dilatation before and after the intravitreal injection of ranibizumab was observed one week after injection.Laser photocoagulation was used as adjuvant therapy if the plus disease persisted more than two weeks or new-onset ridge occurred after injection.The mean time interval between injection and laser therapy was (5.1 ±2.6) weeks (range,1-10 weeks).Follow-up ranged from 6 to 18 months,with a mean of (10.3±3.9) months.The anatomical results and complications were evaluated after treatment.The eyes that progressed to stage 4 or 5 during the follow-ups were underwent lens-sparing vitrectomy or lensectomy combined with vitrectomy.Results No major systemic or ocular complications were observed.Preretinal hemorrhages were found in 12 eyes of 8 patients (17.1％),but they were absorbed spontaneously during the follow ups.All lens remained transparent and no iatrogenic retinal hole was occurred during the follow-ups.After the injection,the regression of iris neovascularization was observed in 46 eyes within one week,vitreous hemorrhage absorbed significantly in 16 eyes (84.2 ％％),and plus disease disappeared completely within one week in 61 eyes (87.1％).59 eyes (84.3％) demonstrated vascularization toward the peripheral retina after treatment.32 out of 42 eyes (76.2 ％) with zone 1 demonstrated vascularization toward to zone 2,while 24 out of 28 eyes (85.7％) with zone 2 demonstrated vascularization toward to the junction of zone 2 and 3.After intravitreal injection of ranibizumab combined with laser photocoagulation,62 of 70 eyes (88.6％) had retinal vascular ridge and plus disease regression.However,8 eyes of 6 patients (11.4％) showed significant fibrovascular proliferation and progressed to retinal detachment after the combination treatment of intravitreal ranibizumab injection and laser photocoagulation.Four eyes underwent lens-sparing vitrectomy,while the other 4 eyes underwent vitrectomy combined with lensectomy.Five eyes achieved totally retinal reattachment after surgery,while 3 eyes achieved partially retinal reattachment.Conclusion The combination of intravitreal injection of ranibizumab and laser photocoagulation is safe and effective in the treatment of AP ROP. Key words: Retinopathy of prematurity/therapy; Antibodies,monoclonal/ therapeutic use; Laser coagulation