Serial evaluation of retinal vascular changes in infants treated with intravitreal bevacizumab for aggressive posterior retinopathy of prematurity in zone I

Abstract

Purpose To evaluate the serial changes in retinal vasculature in infants treated with intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity (APROP) in zone I. Methods Retrospective analysis of serial changes in retinal vasculature after IVB in the seven eyes of four babies with APROP in zone I. Results The initial regression, following IVB, was dramatic with reduction in vessel caliber and marked thinning and invisibility of the bridging shunts. Resurgent vascular development was very slow radially though there was continued abnormal vascular growth circumferentially. Common findings in all eyes were tangled vasculature and fine saw-toothed shunts. The variable findings were (1) new closely packed multilayered bridging shunts, long arching mature looking vessels, and finally a ridge at the periphery (n = 3 eyes) at 52 weeks of postmenstrual age (PMA); (2) status quo at the stage of saw-toothed shunt and ridge in both eyes for a long time (n = 2 eyes); and (3) multiple retinal hemorrhages within the vascularized retina and thick preretinal hemorrhage overlying the saw-toothed shunts and ridge that persisted for another 3 weeks and regressed 2 weeks after laser (n = 1). The eyes that received bevacizumab alone (3) did not show any abnormal vascularization at 56 weeks of PMA or beyond. Conclusions The retinal vascularization following IVB was different than normal in terms of its time, speed, and morphology; few of these changes are first to be reported in the literature (Medline search) and warrants further studies.

Combined intravitreal ranibizumab and zone I sparing laser ablation in infants with posterior zone I retinopathy of prematurity

“…reported three phases of vascular changes following IVB in eyes with zone I ROP mainly phase 1: rapid regression of plus disease; phase 2: slow vascular development and lastly, phase 3: there may be complete regression on follow-up or progression to rebound/recurrent ROP. [ 23 ]…”

Anti-vascular endothelial growth factor in the management of retinopathy of prematurity: A survey among the members of Indian Retinopathy of Prematurity Society

“…[ 35 ] However, various studies on IVI in infants with ROP have reported the safety of injection at 1 mm, 1.5 mm as well as 2 mm from the limbus. [ 10 15 36 37 ] The current survey shows 51.1% of respondents injecting IVI at 1 mm from the limbus, and a nearly equal number (41.9%) injecting at 1.5 mm from the limbus.…”

Antivascular endothelial growth factor in the treatment of retinopathy of prematurity

“…Padhi et al examined changes in retinal vasculature after IVB for APROP in zone 1 and showed a rapid decrease of disease activity within a week of injection followed by a low phase of vascular development. On continued observation, ROP in eyes treated with laser regressed in an expected pattern within 3 weeks, as compared with bevacizumab-treated eyes where peripheral vascular abnormalities persisted even up to 1 year [18]. Lepore et al reported a series of 12 infants with type 1, zone 1 ROP who were treated with IVB in one eye and conventional laser in the fellow eye.…”