Abstract
We report our experience with the use of intravitreal ranibizumab for the treatment of retinopathy of prematurity (ROP). A retrospective review was performed on 138 consecutive infants screened at a single centre over 18 months. Intravitreal ranibizumab was offered in selected cases requiring treatment, such as aggressive posterior ROP or poor mydriasis. 2 eyes of 1 infant received intravitreal ranibizumab alone and 8 eyes of 5 infants received combined intravitreal ranibizumab and laser therapy. 3 out of 8 eyes treated initially with intravitreal ranibizumab monotherapy had persistent disease requiring laser therapy, and 3 out of 5 eyes with initial regression suffered disease recurrence at a mean of 7.6 weeks post-injection. 2 eyes treated first with laser followed by intravitreal ranibizumab had disease regression without recurrence. Our cohort demonstrate a significant rate of persistent disease and recurrence in ROP eyes treated initially with intravitreal ranibizumab monotherapy, which is greater and earlier than that reported for intravitreal bevacizumab in the BEAT-ROP study. Intravitreal ranibizumab may be useful as an initial treatment in selected cases of ROP when laser therapy as first line is suboptimal. However, close monitoring is important and adjunctive laser therapy may subsequently be needed in a majority of cases.
Highlights
Factor plays an important role in stimulating retinal neovascularization and elevated levels have been detected in eyes with ROP13–15
Conventional laser therapy was the treatment of choice, but intravitreal anti-VEGF was offered in selected cases, such as aggressive posterior retinopathy of prematurity (APROP), and cases with poor pupil dilation and/or media opacity whereby laser therapy could not be performed
Results from our study demonstrate a significant rate of persistent disease as well as recurrence after regression in Retinopathy of prematurity (ROP) eyes treated initially with intravitreal ranibizumab monotherapy
Summary
Factor plays an important role in stimulating retinal neovascularization and elevated levels have been detected in eyes with ROP13–15. The most commonly reported anti-VEGF agent, bevacizumab, has been shown to have significant benefit in treating ROP in zone I, but not posterior zone II, stage 3 plus disease when compared with conventional laser therapy in the BEAT-ROP trial[16]. Advantages of intravitreal anti-VEGF therapy compared with conventional laser therapy include reduced treatment time, avoidance of a general anaesthesia, suitability in infants with poor fundal view due to anterior segment involvement, which avoids ablation of and allows further vascularization of the peripheral retina especially in posterior disease, and possibly better refractive outcomes[17,18]. The ideal dosing, optimal technique of injection, risk of reactivation and long-term systemic safety are still unknown and remain important concerns associated with the use of intravitreal anti-VEGF therapy for ROP. We report our experience with the use of intravitreal ranibizumab, in combination with laser therapy if necessary, for the treatment of ROP
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