Ranibizumab Injection as Primary Treatment in Patients with Retinopathy of Prematurity

Huang, Qiren; Zhang, Qi; Fei, Ping; Xu, Yu; Lyu, Jiao; Ji, Xunda; Peng, Jie; Li, Yi-An; Zhao, Ping

doi:10.1016/j.ophtha.2017.03.018

Cited by 69 publications

(63 citation statements)

References 32 publications

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“…Our inclusion criteria are broader than the screening guideline recommendations in the USA (GA <30 weeks, BW <1500 g) and UK (GA <32 weeks, BW <1500 g)1 22 because severe ROP occurs in more mature and larger infants in China 23 24. The mean PMA for the time of first IVC is 34.2±1.9 weeks and 5.8±1.4 weeks, which is in accordance with 36.6±3.2 PMA by Wu et al and 36.0±2.34 PMA by Huang et al in the study of bevacizumab and ranibizumab treatment for infants with ROP, respectively,25 but slightly earlier than the 38.47±2.72 weeks reported by Jin et al 26. We found that using an IVC injection once, as monotherapy, resulted in the regression of plus disease without recurrence in 83.7% (40/48) of eyes with type 1 ROP and AP-ROP.…”

Section: Discussionsupporting

confidence: 88%

Efficacy of intravitreal conbercept injection in the treatment of retinopathy of prematurity

et al. 2018

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Section: Discussionsupporting

confidence: 88%

Efficacy of intravitreal conbercept injection in the treatment of retinopathy of prematurity

et al. 2018

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“…The difference was significant only for ROP located in retina Zone I (the most posterior region of the retina). (4) This study was followed by several case series, (5)(6)(7) small trials (8)(9)(10) and two small dosing studies. (11,12) In clinical practice, anti-VEGF agents are increasingly being used worldwide to treat ROP.…”

Section: Introductionmentioning

confidence: 99%

Ranibizumab versus laser therapy for the treatment of very low birthweight infants with retinopathy of prematurity (RAINBOW): an open-label randomised controlled trial

et al. 2019

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Background: Current therapy does not eradicate ocular morbidity and visual disability following retinopathy of prematurity. Anti-vascular endothelial growth factor treatment provides a potentially new treatment. Methods: Infants with birth weight <1,500g meeting established criteria for ROP treatment were recruited in 87 neonatal and ophthalmology centres in 26 countries. We performed a randomised, multicentre, open-label, 3arm, parallel-group study evaluating efficacy and safety of intravitreal injection of ranibizumab 0•2mg or ranibizumab 0•1mg against laser therapy. The primary outcome was treatment success, defined as survival with no active retinopathy, unfavourable structural outcomes or the need for an additional treatment modality at or before 24 weeks. Findings: Treatment success occurred in 56/70 (80%) infants receiving ranibizumab 0•2mg compared with 57/76 (75%) receiving ranibizumab 0•1mg and 45/68 (66%) infants following laser therapy. The odds ratio of a successful outcome following ranibizumab 0•2mg compared with laser therapy was 2•19 (95% confidence interval 0•99-4•82; p=0•051). One infant had an unfavourable structural outcome following ranibizumab 0•2mg, compared to five following ranibizumab 0•1mg and seven after laser therapy. Ranibizumab 0•2mg was effective in both Zone I and Zone II disease. Ranibizumab 0•1mg offered no advantage over 0•2 mg. Death, serious and non-serious systemic and ocular adverse events were evenly distributed between the three groups. Interpretation: In the treatment of retinopathy of prematurity, ranibizumab 0•2mg was effective with fewer unfavourable ocular outcomes than laser therapy and with an acceptable short-term safety profile. Funding: Novartis Pharma; RAINBOW ClinicalTrials.gov number, NCT02375971.

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“…Similarly, in our study, the 39 eyes from the 21 patients whose PMA at the first IVR injection was ≤35.4 weeks also did not progress to retinal detachment. However, Zhao et al [ 16 ] reported that retinal detachment occurred in 5 of the 49 eyes (10.2%) with APROP in patients given the first IVR injection at a mean PMA of 37.3 ± 5.2 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…Yoshihiro et al reported that infants who were injected at an older PMA progressed to tract retinal detachment more quickly [ 17 ]. A single burst of VEGF contributes to neovascularization during the ROP process [ 18 ], and late IVR treatment during the period when the VEGF levels are decreasing may induce fibrosis and contraction of flat neovascularization peripherally to cause tight detachment [ 16 , 17 ]. Our study showed high proportions of APROP patients with older PMAs, because our hospital is a tertiary referral center in Beijing, and we receive patients with severe ROP from all parts of the country.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and prognostic factors for aggressive posterior retinopathy of prematurity following initial treatment with intravitreal ranibizumab

et al. 2018

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BackgroundThis study sought to identify factors associated with retinal detachment and retreatment of aggressive posterior retinopathy of prematurity (APROP) initially treated with intravitreal ranibizumab (IVR) injection as well as the efficacy of IVR treatment.MethodsThis was a retrospective study. A total of 83 preterm infants (160 eyes) diagnosed with APROP who were primarily treated with IVR were included. The 160 eyes were divided into two groups based on the anatomic outcomes. Group A included 35 eyes that developed retinal detachment, and Group B included 125 eyes without retinal detachment. The following patient factors were retrospectively reviewed: gender, gestational age (GA), birth weight (BW), postmenstrual age (PMA) at first treatment, iris neovascularizations, retinal hemorrhage, neutrophil and lymphocyte counts before the first intravitreal injection, neutrophil-to-lymphocyte ratio (NLR), anatomical outcomes, additional treatment and follow-up time. Three dummy variables were created as dependent variables based on the methods of retreatment. The possible risk factors for APROP were evaluated, and statistical analyses included univariate and multivariate logistic regression.ResultsA total of 160 eyes from 83 preterm infants (56 males and 27 females) underwent initial IVR treatment with a follow-up time of 17.17 ± 10.54 months. Thirty-five of the 160 (21.9%) eyes progressed to retinal detachment, and 82 of the 125 (65.6%) non-retinal detachment eyes needed retreatment, with favorable anatomical outcomes. The disease improved approximately 1.5 ± 1.2 weeks after the first IVR treatment. The mean recurrence period of APROP was approximately 7.5 ± 6.9 weeks after the first IVR treatment. Multiple logistic regression analysis revealed postmenstrual age (P < 0.001) and neutrophil count (P = 0.009) as the most significant factors for retinal detachment in APROP. Retinal hemorrhage (P = 0.007) and BW (P = 0.04) were most significantly associated with APROP recurrence and retreatment.ConclusionsIVR injection is an effective treatment for APROP. In this study, older postmenstrual age and low neutrophil count were identified as risk factors for retinal detachment in APROP. In addition, retinal hemorrhage and low BW were significantly associated with recurrence and retreatment in non-retinal detachment APROP. Thus, patients with a lower BW, older postmenstrual age, low neutrophil count and retinal hemorrhage should be reexamined in a timely and more frequent manner.

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Ranibizumab Injection as Primary Treatment in Patients with Retinopathy of Prematurity

Abstract: Intravitreal injection of ranibizumab seemed to be effective in treating patients with ROP. After treatment, there were primarily 3 different outcomes. Our predictive tree model is helpful for ophthalmologists to evaluate the risk of reactivation.

Cited by 69 publications

References 32 publications

Efficacy of intravitreal conbercept injection in the treatment of retinopathy of prematurity

Efficacy of intravitreal conbercept injection in the treatment of retinopathy of prematurity

Ranibizumab versus laser therapy for the treatment of very low birthweight infants with retinopathy of prematurity (RAINBOW): an open-label randomised controlled trial

Outcomes and prognostic factors for aggressive posterior retinopathy of prematurity following initial treatment with intravitreal ranibizumab

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