Aggressive Posterior Retinopathy Of Prematurity Research Articles

Long‐term observation of the treatment of laser photocoagulation versus intravitreal bevacizumab in identical twins with aggressive posterior retinopathy of prematurity

AbstractPurposeIn recent years, a number of studies have been reported comparing the results of the treatment with intravitreal bevacizumab injection. We report a case of comparing effects of laser photocoagulation versus intravitreal bevacizumab injection in identical twins with AP‐ROP.MethodsGA 28 + 2 weeks, identical twins were born with 0.97 and 1.02 kg. Twins were diagnosed as bilateral AP‐ROP and they were refered to different hospital due to the lack of hospital neonatal room, and they received different treatments. At the PMA 32 + 6 weeks, the older sister underwent bilateral intravitreal bevacizumab injection, younger sister underwent laser photocoagulation. Younger sister underwent bilateral laser photocoagulation at the PMA 34 + 4 weeks and received additional bilateral intravitreal bevacizumab injection after 1week. Older sister underwent second intravitreal bevacizumab injection at the PMA 42 + 2 weeks.ResultsAfter 9 years, older sister’s BCVA was checked 0.8 in the right eye, 0.25 in the left eye. Both eyes showed good angiogenesis to the periphery of the retina and fovea showed normal development on the OCT. And younger sister’s BCVA was checked 0.5 in the right eye, FC 50cm in the left eye. Laser was well applied at the periphery, but the retinal vessels didn’t grow even in the zone 1 main arcade, and the fovea on the OCT was irregular and undeveloped.ConclusionsIn this case, the intravitreal bevacizumab injection in the same twin with all the same conditions supports the efficacy of bevacizumab injections because of better long‐term outcome of anatomical and functional retinal vessel development. There is no reported case of different initial treatment in Identical twin, so it can be a meaningful case to compare long term results of two treatments.

Fluorescence Angiography-assisted Management of Recurrences in Aggressive Posterior Retinopathy of Prematurity (APROP) after Intravitreal Monotherapy with 0.312 mg Bevacizumab

In cases of aggressive posterior retinopathy of prematurity (APROP), recurrences can occur after intravitreal injection of bevacizumab (IVB), in spite of successful treatment of the acute stage. Therefore, long-term examinations in extremely premature patients are needed. We defined recurrences as a relapse of plus disease and leakage (with or without proliferation) at the vascularisation border, but also anterior and posterior to it. RetCam wide-field colour images and fluorescein angiography were performed before the first IVB (0.312 mg bevacizumab in 0.025 ml per eye), before each further therapy, i.e. additional intravitreal injection, laser- or cryocoagulation or pars-plana vitrectomy, and at the end of the therapy. We analysed the images of 18 eyes with APROP of 9 extreme premature patients treated between 08/2007 and 12/2017 (GA 21 - 27 weeks, BW 430 - 890 g). Long-term therapeutic success was achieved in only 4eyes/2 children (22%) with one single injection. In 2 eyes/2children (11%), a second and third injection was given within 2 weeks because of an insufficient therapeutic effect. Up to 3 injections together with laser coagulation were needed in 12 eyes/6 children (67%), in order to achieve complete resolution of ROP activity. In 6 eyes/2 children (33%), resolution of leakage at the original vascularisation border was achieved only with further laser coagulation. In one single eye, retinal detachment occurred after unsuccessful retinal surgery. Before IVB, fluorescein angiography disclosed leakage due to proliferation in most of the patients (12 eyes/6 children). In recurrences after IVB, a posterior shift of the leakage site was found (14 eyes/4 children), whereas after laser photocoagulation proliferative changes were also detected anterior to the vascularisation border (5 eyes/3 children). Treatment was indicated based on angiographic findings in 14 eyes/4 children where wide-field colour images did not show plus disease or proliferation. Intravitreal injection of 0.312 mg bevacizumab has been shown to be an effective therapy for the acute stage of APROP. Long-term success required consequent monitoring and treatment of APROP recurrences. Fluorescein angiography was particularly useful to detect recurrences that were not evident in wide-field colour images.

Characterization of the Progression Pattern in Retinopathy of Prematurity Subtypes

To evaluate differences in the progression pattern among subtypes of retinopathy of prematurity (ROP). Retrospective cohort study. Premature infants screened for ROP. Medical records of 578 premature infants who were screened at the neonatal intensive care unit from September 2009 through March 2016 were reviewed. We matched for the number of patients, gestational age at birth, and postmenstrual age at the first examination between infants with spontaneously regressed ROP and those with treated ROP. A total of 133 premature infants who were born before 27 weeks' gestation were included. The mean age at onset of any ROP and the duration from the initial examination to onset were compared between infants with regressed ROP and those with treated ROP. The mean age at treatment and the duration from onset to treatment were compared between infants with type 1 ROP and those with aggressive posterior ROP (AP-ROP). Data were analyzed for 1 randomly selected eye for each infant. Of 133 premature infants with any ROP, 67 regressed spontaneously, 43 demonstrated type 1 ROP, and 23 demonstrated AP-ROP. Individual trajectories of ROP progression over time showed that AP-ROP progressed through the stages in a steep linear manner in most cases. In contrast, the type 1 ROP and regressed ROP developed in a slower, stepwise manner. In infants with ROP, the disease trajectories across ROP stages are different based on the ROP subtype, despite postmenstrual age at onset being comparable across subtypes. Our findings could be useful for managing follow-up screening.

Correction to: Assessment of vascular leakage and its development with FFA among patients treated with intravitreal anti-VEGF due to aggressive posterior ROP.

In the original publication, the authors' affiliations were published incorrectly.

Favorable outcomes in the treatment of aggressive posterior retinopathy of prematurity.

To report the results of intravitreal ranibizumab injection as primary therapy in aggressive posterior retinopathy of prematurity, the process of the disease, and the additive treatments performed. This retrospective case review included 15 eyes of 8 premature babies with aggressive posterior retinopathy of prematurity who were initially treated with intravitreal ranibizumab injection. The documented data were gestational age, birth weight, gender, postmenstrual age at intravitreal ranibizumab injection, zone of retinopathy of prematurity, reactivation time of disease, iris neovascularization, retinal hemorrhage, anatomical outcome, and additional treatment. Median gestational age at birth was 26 (range, 23-27) weeks, birth weight was 730 (range, 550-970) g, and postconceptional age at aggressive posterior retinopathy of prematurity diagnosis and intravitreal ranibizumab injection was 35 (range, 33-35) weeks. Intravitreal ranibizumab injection was performed as primary treatment. Two eyes necessitated a second intravitreal ranibizumab injection. The reactivation of retinopathy of prematurity was 5 (range, 3-7) weeks after intravitreal ranibizumab injection. Recurrence of the disease in Zone II was treated with laser photocoagulation. A favorable outcome was obtained in all eyes (100%). Aggressive posterior retinopathy of prematurity is a serious, rapidly progressing form of retinopathy of prematurity that requires quick and proper management. This study indicates that primary treatment with ranibizumab and laser photocoagulation on recurrence provide favorable anatomical outcomes.

Intravitreal bevacizumab injection in aggressive posterior retinopathy of prematurity compared with type I retinopathy of prematurity.

To compare type I retinopathy of prematurity (ROP) with aggressive posterior retinopathy of prematurity (AP-ROP) regarding risk factors, complications and treatment outcomes. A prospective cohort approach was applied on premature newborns diagnosed as type I ROP and AP-ROP. An intravitreal injection of bevacizumab (Avastin®) was given to each patient. Demographic features such as gestational age, birth weight, age at the initial injection, involved eye, treatment response, relapses and need to extra interventions were compared. Seventy-seven patients underwent an initial intravitreal injection of bevacizumab (IVB), and 108 eyes were type I ROP and 30 eyes were AP-ROP. There was no significant difference in birth weight and gestational age between two groups. ROP relapsed in eight eyes of four patients with AP-ROP (26.6%), of which six eyes of three patients received re-injection of bevacizumab, and two eyes of one patient underwent a laser treatment. Recurrence occurred in two eyes of one patient with type I ROP (1.8%), which were treated by laser. Bilateral eye involvement, relapse and retreatment (IVB, laser and surgical intervention) are more frequent in AP-ROP than type I ROP even when treated with intravitreal bevacizumab injection.

Aggressive posterior retinopathy of prematurity in two cohorts of patients in South India: implications for primary, secondary, and tertiary prevention

Aggressive posterior retinopathy of prematurity (APROP), which has a poor visual prognosis, is common in low- and middle-income countries (LMICs) as a result of suboptimal oxygen monitoring (primary prevention). The purpose of this study was to compare outcomes in APROP eyes treated with laser to eyes treated with antivascular endothelial growth factor (anti-VEGF) therapy. The medical records of a cohort of APROP eyes treated with anti-VEGF (2010-2018) and another of eyes treated with laser photocoagulation (2002-2010) at the same institution in South India were reviewed retrospectively and compared. The main outcome was the proportion of eyes developing retinal detachment during resolution of acute ROP. A total of 398 eyes of 199 preterm babies with APROP were included: 168 eyes were treated with photocoagulation; 230, with anti-VEGF. From 2002 to 2010, compared to the more recent cohort, babies diagnosed with APROP tended to be heavier (P<0.001), older (P<0.001), and exposed to fewer days of oxygen (P=0.02). In the laser-treated cohort, 17 of 168 eyes (10%) developed retinal detachment (7, stage 5; 12, stage 4), compared with 3 of 230 (1%) in the anti-VEGF cohort (all stage 4 [P=0.002]). The incidence of retinal detachment was significantly lower in eyes treated with anti-VEGF compared with laser-.treated eyes In the absence of a randomized trial, these data suggest that anti-VEGF may lead to better anatomic outcomes, although questions remain concerning dosage, timing, and risks.

Risk factor analysis for the development and progression of retinopathy of prematurity.

PurposeTo classify the risk factors that contribute to the development versus progression of retinopathy of prematurity (ROP).MethodsThe medical records of premature infants born with a birth weight (BW) less than 1501 g or a gestational age (GA) of 32 weeks or less were retrospectively reviewed. Twenty potential risk factors that may influence the development or progression of ROP were analyzed by univariate and multivariate logistic regression analyses. The progression of ROP was defined as type 1 ROP, threshold ROP, or aggressive posterior ROP for which treatment was recommended.ResultsA total of 324 eyes were included; 157 eyes (48.5%) showed ROP development, and 48 eyes exhibited ROP progression (14.8% of all eyes and 30.6% of the ROP-developed eyes). According to the univariate and multivariate logistic regression analyses, prenatal steroid use, GA, the duration of mechanical ventilation, and respiratory distress syndrome were associated with the development of ROP. However, GA, bronchopulmonary dysplasia, the number of red blood cell units transfused, intraventricular hemorrhage, and periventricular leukomalacia were significantly correlated with ROP progression.ConclusionThe risk factors that influenced ROP development versus ROP progression were not identical. Evaluating these risk factors during screening of high-risk premature infants will help determine the appropriate timing of examinations and treatment.

The Fluorescein Angiographic Signs of Aggressive Posterior Retinopathy of Prematurity

The purposeis to study the fluorescence angiographic signs of posterior aggressive retinopathy of prematurity.Patients and methods. A prospective study of 83 infants with aggressive posterior retinopathy of prematurity (APROP), who were on treatment in the neonatal center in 2012–2018 years. Gestational age was between 22 and 30 weeks. Depending on the diagnostic methods, patients were divided into two groups: 1 (main) — 51 (61.4 %) children who, in addition to standard ophthalmic examination methods, received 132 series of FA using a pediatric retinal camera RetCam3; 2 (control) — 32 (38.6 %) children without FA. After the procedure, the somatic state of the child was monitored for 24 hours for the registration of drug dye side effects.Results. Angiographic predictors of the disease and objective signs of APROP manifestation were presented in group 1 children a week earlier than in the group 2. This made laser treatment possible on 2.0 ± 0.5 weeks earlier in the group 1 (32.8 ± 1.2 weeks) compared to group 2 (34.8 ± 1.7 weeks) (p &lt; 0.05) and to increase its efficiency by 8.2 % (86.3 and 78.1 % respectively).Conclusion. Comparative analysis of angiograms and color fundus images obtained with RetCam3 in the studied groups of children demonstrates the advantages and safety FA for the detection angiographic predictors of APROP, early objective signs of disease manifestation, it provides timely and effective laser treatment of complicated categories of very premature infants.

Aggressive Posterior Retinopathy of Prematurity Treated with Intravitreal Bevacizumab: Late Period Fluorescein Angiographic Findings.

To evaluate vascularization end limit of the peripheral retina and describe vascular development patterns of patients at the late period with aggressive posterior retinopathy of prematurity (APROP) who were treated with a single intravitreal injection of bevacizumab. All patients were examined with RetCam III and fluorescein angiography (FA) within 90-100 gestational week. The vascularization end limit according to the zones and vascular structural abnormalities were noted. A total of 116 eyes of 58 patients were included. The mean gestational age and birth weight were 28.31 ± 2.5 (23-33)weeks and 1156.29 ± 386.38 (360-2300)g, respectively. The mean age at the time of FA was 95.09 ± 3.8 (90-100)weeks. According to the vascular termini, four eyes (3.4%) were in zone II posterior, 30 eyes (25.8%) were in zone II anterior, 22 eyes (18.9%) were in zone III with a distance of > 2 disc diameter (DD) from ora serrata, and 60 eyes (51.7%) were in zone III with a distance of < 2 DD from temporal ora serrata. Abnormal vascular findings were detected in 86.2% of patients (100/116 eyes) including circumferential vessels (43.1%), abnormal vascular branching (25.9%), closely packed vascular shunts (6.8%), and vascular leakage (10.3%). FA gives us quantitative data for treatment decision at late period of APROP patients treated with bevacizumab. Fluorescein leakage and persistent avascular areas still detected at FA at 90-100 gestational weeks increase the risk for late complications. FA can detect the abnormalities that can not be detected via indirect ophthalmoscope and be useful for follow-up and further treatments of APROP.

Evaluation of computer-based retinopathy of prematurity (ROP) education for ophthalmology residents: a randomized, controlled, multicenter study

To evaluate the effect of a computer-based training program-Massachusetts Eye & EarROP Trainer-on residents' knowledge of retinopathy of prematurity (ROP) management. In this prospective, randomized study, ophthalmology residents from nine different training programs consented to participate. Those who completed the study were randomly assigned to either the Trainer or the control group. The ROP Trainer was created using clinical cases encompassing the stages of ROP in digital pictures and videos. It includes sections on screening decisions, examination techniques, and diagnosis, and a reference section with the expert video clips and a searchable image library. Subjects in the control group were asked to study standard print material on ROP. A pre- and post-test, consisting of theoretical and practical (diagnosis) questions, and a post-intervention satisfaction test were administered. Accuracy of ROP diagnosis was assessed. A total of 180 residents agreed to participate, of whom 60 completed the study. Residents in the Trainer group had statistically significant improvements (P=0.003) in ROP knowledge and diagnostic ability (P=0.005). Residents randomized to the Trainer group were more satisfied with the training materials than were those in the control group. There was no significant difference in improving knowledge by year of training, sex, or country. Considering all training levels, a statistically significant increase was observed in sensitivity for the diagnosis of preplus or worse, zone I or II, ROP stage, category, and aggressive posterior ROP in the Trainer group. In this study, the Trainer was shown to significantly improve ROP knowledge and diagnostic skills of residents, regardless of sex, year, of training, or country.

Assessment of vascular leakage and its development with FFA among patients treated with intravitreal anti-VEGF due to aggressive posterior ROP.

Evaluation of vascular leakage and retinal vascular development with fundus fluorescein angiography for infants diagnosed with aggressive posterior retinopathy of prematurity who underwent intravitreal anti-VEGF treatment. Medical recordings of 30 patients who received RetCam fluorescein angiography during follow-up and had been treated with anti-VEGF on diagnosis of aggressive posterior ROP in the zone I or zone II between the dates of April 2014-January 2017 were evaluated retrospectively. Fifty-nine eyes of 30 patients were included in the study. Mean birth weight was 1145g; gestation week was 28.4. Recurrence occurred in 30.5% of the patients, and 10.1% of them were given a second dose of injection of anti-VEGF. Leakage was detected in 15.3% of the eyes during angiography, and all of these eyes were treated with laser photocoagulation. Evaluation of vascular development revealed that in the temporal, complete retinal vascular development was achieved in only 8% of the eyes. It was detected that complete retinal vascularization was not observed in any of the cases which were given second dose of injection due to recurrence. The patients were distributed into groups according to postmenstrual week taken to angiography as 32 eyes of 16 patients in group 1, 17 eyes of 9 patients in group 2 and 10 eyes of 5 patients in group 3. The vascular leakage rate of group 3 patients was statistically significantly higher (p < 0.05) and vascular development between groups was not statistically significant (p > 0.05). With the initiation of FFA usage in pediatric cases, especially treated with anti-VEGF due to retinopathy of prematurity (ROP), more findings (vascular arrest, leakage, and abnormalities, etc.) are obtained than those achieved via ophthalmoscopic examination. In the light of these findings, early intervention with laser photocoagulation in early stages becomes possible enabling prevention of possible blindness.

Refractive outcomes comparing primary laser to primary bevacizumab with delayed laser for type 1 ROP

To compare the refractive outcomes of intravitreal bevacizumab (IVB) and delayed peripheral retinal photocoagulation (PRP) with primary PRP in infants treated for posterior type 1 ROP. The medical records of 87 infants at a tertiary referral center treated for posterior type 1 ROP between 2006 and 2016 were reviewed retrospectively. Consecutive infants received primary PRP before and primary IVB after a change in treatment practice implemented in early 2011. In most cases primary IVB was supplemented with prophylactic laser treatment after 60weeks' PMA (IVB-PRP). The main outcome was spherical equivalent (SE) in diopters, determined by cycloplegic refraction between 2 and 4years. Infants treated with IVB-PRP were also compared to the those who received only IVB as monotherapy. The final analysis included 34 eyes of 19 infants in the primary PRP group and 40 eyes of 21 infants in the IVB-PRP group. Mean SE was -7.4±5.2 D in the primary PRP group and -0.16±2.2 D in the IVB-PRP group (P<0.001). This relationship persisted after stratification by zone of ROP and the presence of aggressive posterior ROP. There was no statistically significant difference in mean SE between the IVB-PRP group and the 8 eyes of 4 infants who received IVB as monotherapy. Of 46 infants who received primary IVB, 37 completed an examination under anesthesia after 60weeks' PMA. In these patients, 70% of eyes showed peripheral vascular leakage on fluorescein angiography. In our study cohort, infants treated with IVB-PRP were significantly less myopic than those treated with primary PRP. Delayed laser after 60weeks' PMA, in hopes of reducing the risk of late reactivation with retinal detachment, did not negate the refractive benefits of primary IVB.

Commentary: Antivascular endothelial growth factor and retinopathy of prematurity.

Commentary: Antivascular endothelial growth factor and retinopathy of prematurity.

Prevalence, risk factors and pattern of severe retinopathy of prematurity in eastern Madhya Pradesh.

Purpose:To describe the prevalence, characteristics including risk factors, and pattern of severe ROP from eastern Madhya Pradesh region of India.Methods:In this 5-year retrospective study, Baseline characteristics, systemic risk factors, and findings of ROP screening were noted. Factors associated with severe ROP including aggressive posterior ROP (APROP), stage IV and V ROP were analyzed. Statistical analysis was done using SPSS version 20.Results:Of 763 babies screened, 30% were diagnosed to have ROP. Prevalence of severe ROP was 14.2% (109) of which 60 (55.5%) were classic and 30 (27.7%) were APROP. Eighteen (16.6%) were diagnosed as advanced ROP (stage IV and V). Mean gestational age (GA) and birth weight (BW) for severe ROP were 31.05 weeks and 1.34 kg, respectively which were inversely associated with severe ROP. But a significant 10% of severe ROP were seen in late preterm babies, >34 weeks. Low GA and respiratory distress syndrome (RDS) were significant risk factors for APROP. Most important factor for stage IV and V ROP was late presentation for screening.Conclusion:The study found a high prevalence of severe ROP including APROP. Almost 7% severe ROP cases were outside screening guidelines of NNF. Late presentation for screening is the most important factor associated with ROP related blindness.

Neonatal Intensive Care Unit-based screening program for retinopathy of prematurity and its treatment in an Indian population.

Purpose:The purpose was to study the incidence, risk factors, and anatomical outcomes after laser treatment in retinopathy of prematurity (ROP).Methods:A retrospective observational study was carried out. Infants admitted to Neonatal Intensive Care Unit of 12 referral hospitals between April 2016 and September 2017 were screened according to the latest Indian guidelines based on the International Classification of Retinopathy of Prematurity.Results:The incidence of ROP in 1648 eyes screened was 25.36% (418 eyes), out of which high-risk prethreshold ROP (type 1) was observed in 9.95% (164 eyes). Decreased hemoglobin (P < 0.001), oxygen requirement (P = 0.008), and number of blood transfusions (P = 0.037) were significant with type 1 than type 2 (low-risk prethreshold) ROP. Stages 1, 2, and 3 were observed in 82 (32.28%), 154 (60.62%), and 18 (7.08%) eyes, respectively. Aggressive posterior ROP (APROP) was observed in 20.73% eyes with type 1 ROP. Ten eyes showing APROP were treated at an early gestational age of 29 weeks. All infants with type 1 ROP were treated with laser photocoagulation only.Conclusion:One-fourth of the infants showed ROP and one-tenth needed laser photocoagulation, the outcome of which was excellent. Risk factors predisposing to ROP were anemia, high oxygen supplementation, increased number of blood transfusions, and septicemia. ROP screening in infants ≥1700 g birth weight associated with various systemic risk factors may be beneficial in the Indian population.

Agresif Posterior Prematüre Retinopatisinin Anti-VEGF Ajanlardan Aflibersept ile Tedavisi

Agresif Posterior Prematüre Retinopatisinin Anti-VEGF Ajanlardan Aflibersept ile Tedavisi

Intravitreal aflibercept injection in Indian eyes with retinopathy of prematurity.

Purpose:To study the efficacy of intravitreal Aflibercept, an anti Vascular Endothelial Growth factor, (anti-VEGF) in Retinopathy of Prematurity (ROP).Methods:This was a retrospective, interventional consecutive case series of 46 Indian eyes which received intravitreal injection of Aflibercept for High risk Prethreshold ROP, Threshold ROP, and Aggressive-Posterior ROP (AP-ROP).Results:Aflibercept was effective in achieving the primary endpoint, namely regression of ROP following the injection in all 46 eyes (100%) at one week following the injection. 32.6% (15/46) of eyes achieved secondary endpoint namely complete vascularization, with no recurrence of ROP at varying time intervals: as early as 15 weeks to as late as 29 weeks after injection, at intervals ranging from 49 to 64 weeks PCA.Conclusion:Intravitreal Aflibercept was effective in inducing complete regression of all types of ROP in all the eyes in our series. In addition, 32.6% of cases did not need a secondary intervention, with no recurrence of ROP and complete vascularization of the retina. In 81.8% of Zone I ROP eyes, Aflibercept facilitated continuation of retinal vascular development following regression of ROP, resulting in less extensive laser during treatment of ROP recurrence. This is the largest series of Aflibercept in ROP, till date as per MEDLINE search.

Intravitreal Ranibizumab Injection for the Treatment of Retinopathy of Prematurity

Objectives: To evaluate the efficacy of a single injection of 0.3 mg intravitreal ranibizumab for the treatment of retinopathy of prematurity (ROP). Methods:We conducted this retrospective case series study at King Abdul Aziz Medical City, Riyadh, Saudi Arabia. Seventy-four eyes of 37 preterm infants with ROP stage III with plus disease in zone I, posterior zone II, and aggressive posterior ROP received a single injection of 0.3 mg intravitreal ranibizumab. The favorable outcome measure was complete regression of the disease with normal vascularization of the retina of those infants. Results: The gestational age of the 37 included cases was in the range of 23–28 weeks and their body weight at birth was between 510 and 1,235 g except for one case with 2,550 g under oxygen therapy <7days with severe hypoglycemia. All eyes showed a favorable response in terms of regression of plus disease from the first day after treatment, followed by regression of stage III retinopathy. All patients developed complete vascularization over variable periods of time. Conclusion: One injection of 0.3 mg intravitreal ranibizumab is effective in treating ROP stage III mainly in zones I and II.

Efficacy of intravitreal aflibercept monotherapy in retinopathy of prematurity evaluated by periodic fluorescence angiography and optical coherence tomography.

To evaluate the efficacy of intravitreal aflibercept (IVA) in vascular and macular maturation in neonates with type 1 retinopathy of prematurity (ROP) and aggressive posterior retinopathy of prematurity (APROP). Thirty-six eyes of 18 patients with type 1 ROP or APROP in zone I or posterior zone II were enrolled in our study. At baseline, only fluorescein angiography (FA) was performed. After IVA injection, both FA and optical coherence tomography (OCT) were performed after 6.8 ± 0.8 (range 6-8) and 19 ± 0.9 (range 18-20) weeks to follow vascular and macular changes. Both diffuse flat neovascularization with leakage and abnormal vascular branching at the small arteriolar level were detected in all eyes (100%) at baseline FA. Regression of the disease was observed in 34 eyes (94.4%) in the first week with binocular indirect ophthalmoscopy. Early unresponsiveness in remaining two eyes of an infant required an IVA re-treatment. Late reactivation was detected only in 19.4% of eyes, none of which required treatment during 12months of follow-up. The most common feature after IVA injection was abnormal branching at capillary level, which was noted in 100% in the first post-injection FA and 50.0% of all eyes in the second FA. Meanwhile, the end limit of vascularization was observed in zone III in 83.3% of eyes. No vascular abnormality was also detected in 27.3% of eyes. The OCT examination at a mean postmenstrual age of 43.4weeks revealed cystoid macular changes in four eyes of two infants (11.1%), normal foveal contour in 30 eyes of 15 infants (83.3%) and matured ellipsoid zone at the foveal center in 28 eyes of 14 infants (77.8%). Macular maturation was complete in all eyes in the last OCT analyses. Intravitreal aflibercept monotherapy has been an effective treatment in type I ROP and APROP with much lower early and late re-treatment rates because of early unresponsiveness and late reactivation, respectively. In most of the eyes, rapid vascular outgrowth beyond zone III together with normal macular maturation was observed more precisely by periodic FA and OCT.