Intravitreal anti‐vascular endothelial growth factor therapy for acute ROP: our management of ten eyes

Abstract

AbstractPurposeTo report our experience in the management of ten eyes with acute Retinopathy of Prematurity (ROP) after intravitreal (i.v.) Anti‐vascular Endothelial Growth Factor (anti‐VEGF) treatment.MethodsA retrospective study was performed in 122 infants screened for ROP over a two year period. Among the 122 premature infants, five (ten eyes), affected by zone 1‐2 type 1 ROP stage II‐III, were selected and treated with an intravitreal injection of Ranibizumab (0.25 mg/0.025 ml). The mean gestational age of the infants was 25 weeks and the mean birth weight 616 g. The treatment was performed at approximately 35 weeks post menstrual age (PMA). At each follow‐up visit, we performed fundus examination with indirect ophthalmoscopy and RetCam III. Fundus photographs and fluorescein angiography (FA) were taken using RetCam III, pre‐treatment and 1 month after treatment. FA was repeated if necessary.ResultsTwo months after treatment, FA showed a reactivation of ROP in four eyes in which we had performed laser photocoagulation. In two eyes FA follow up showed zone 2 angiographic abnormalities that were also laser treated. In the other four eyes vascularisation showed improvement even if the extreme peripheral retina was not fully vascularised, in these cases we decided just to observe. After a follow up of at least six months, the final retinal outcome was assessed. In the six laser treated eyes, laser scars were evident, without any sign of disease reactivation. In the four eyes which were only treated by i.v., we observed the permanence of an avascular zone in the extreme periphery without signs of disease activity.ConclusionsWe experienced that anti‐VEGF treatment allows retinal vascularisation to further progress towards the peripheral retina, so that less laser treatment in the case of ROP progression or reoccurrence is needed. Anti‐VEGF is effective therapy to reach anatomical and functional outcomes, in zone 1‐2 type 1 ROP cases.