Primary intravitreal ranibizumab for high-risk retinopathy of prematurity.

Abstract

To evaluate initial treatment of high-risk retinopathy of prematurity (ROP) with low-dose intravitreal ranibizumab. Case series of premature infants with high-risk pre-threshold or threshold posterior ROP receiving primary therapy with 0.2 mg ranibizumab. Pre-treatment and post-injection examination, RetCam (Clarity Medical Systems, Pleasanton, CA) images, fluorescein angiography, resolution of ROP and plus disease, and stability of examinations were assessed. Eight eyes of four infants received primary ranibizumab treatment. Plus disease resolved within 48 hours of unilateral injection, and there was no change in ROP appearance in the contralateral eye. Complete resolution of stage 3 ROP occurred 1 week after injection. Recurrent progressive stage 2 or 3 ROP in mid to anterior zone 2 was noted 8 to 11 weeks after ranibizumab in all eyes. Treatment of recurrent ROP with peripheral laser led to complete ROP regression. Comparison of images before ranibizumab injection to images after ROP recurred demonstrated anterior retinal growth. Retina examinations remained stable without ROP recurrence or detachment at follow-up 8 to 18 months after ranibizumab injection. Intravitreal ranibizumab induces rapid, complete regression of high-risk posterior ROP with continued retina growth peripherally. The potential for recurrent ROP after a single 0.2 mg ranibizumab injection for posterior ROP requires vigilant monitoring. Subsequent peripheral laser for ROP recurrences may spare the posterior retina from photocoagulation effects.