Predictive factors of early reactivation after ıntravitreal ranibizumab in agressive retinopathy of prematurity

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Objective: Anti-VEGF agents are used in the treatment of aggressive retinopathy of prematurity (A-ROP), which is a rapidly progressive form of retinopathy of prematurity (ROP). This study aimed to evaluate risk factors for the early reactivation after anti-VEGF therapy with intravitreal ranibizumab (IVR) injection.Methods: Consecutive cases of A-ROP were included in this retrospective study. Intravitreal ranibizumab (0.25 mg, Lucentis, Novartis AG) was injected in all A-ROP cases as initial therapy. Probable risk factors were reviewed. A reactivation in 4 weeks or less was defined as” early, “and greater than 4 weeks was defined as” late”. Since reactivations were observed in Zone II in all cases, laser photocoagulation (LP) was performed as rescue therapy.Results: The study consisted of 16 patients with A-ROP, all of whom experienced reactivation. In 6 cases,reactivation was seen early (Group-E), and in 10 cases, reactivation was late (Group-L). The mean gestational age of Group-E and Group-L were 26.60 (±0.89) and 26.73 (±2.10) weeks respectively (p=0.9), and mean birth weights were 918 (±282) and 898 (±0188) grams respectively (p=0.8). Zone I ROP was seen at a higher rate in Group-E (83.3%) than Group-L (30%) (p=0.009). Total O2 treatment duration in Group-E was statistically significantly longer than Group-L (p=0.03). The mean value of platelet distribution width (PDW) in Group-E was statistically significantly higher (p=0.002).Conclusions: In patients with A-ROP, extended duration of O2 therapy and high values of PDW might be factors predictive of early reactivation after intravitreal ranibizumab injection.