Recurrence of Retinopathy of Prematurity After Intravitreal Ranibizumab Monotherapy: Timing and Risk Factors

Lyu, Jiao; Zhang, Qi; Chen, Chunli; Xu, Yu; Ji, Xunda; Li, Jiakai; Huang, Qiren; Zhao, Peiquan

doi:10.1167/iovs.16-20680

Cited by 50 publications

(51 citation statements)

References 29 publications

(62 reference statements)

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“…It is noteworthy that peripheral avascularity and fibrosis after primary IVR at an advanced PMA is a major indication for further ROP management. No ROP recurrence was observed in the study, which is different from previous studies of infants treated at an earlier PMA that showed a substantial rate of ROP recurrence after single IVR [18, 19]. Since physiologic vascularization may slow down at an advanced PMA, it is reasonable to anticipate less recurrent neovascularization, but more peripheral avascularity and fibrogenesis after a single anti-VEGF therapy [6].…”

Section: Discussioncontrasting

confidence: 75%

Ranibizumab injection and laser photocoagulation to treat type 1 retinopathy of prematurity after 40 weeks post menstrual age: a retrospective case series study

et al. 2019

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Background Type 1 retinopathy of prematurity (ROP) is occasionally observed in preterm infants after the postmenstrual age (PMA) of 40 weeks; however, evidence-based treatment guidelines are largely lacking. In this study, we report the clinical characteristics of preterm infants with type 1 ROP at PMA of > 40 weeks and compare the treatment outcomes of intravitreal ranibizumab (IVR) and laser therapy. Methods Twenty-seven eyes of 14 infants, primarily treated for type 1 ROP after 40 weeks PMA by IVR (17 eyes in 9 infants) or by laser photocoagulation (10 eyes in 5 infants) were included in this retrospective analysis. The preoperative fundus characteristics and the structural outcomes and additional treatment after 6 months were analyzed. Results Of the 27 eyes, 20 eyes (74%) had zone II stage 3 plus disease (+) ROP and 7 eyes had zone II stage 2 + ROP. Seventeen (63%) eyes showed thick fibrous ridges. After primary treatment at 40–48 weeks PMA, ROP regression was observed in a similar proportion of eyes in the IVR and laser groups (88% vs. 70%; p = 0.326); complete vascularization was observed in 24% eyes in the IVR group. Compared to laser group, a higher proportion of eyes in IVR group received additional treatment (IVR group 76% vs. laser group 30%; p = 0.040), for unresolved peripheral avascularity in 11 eyes and ROP progression with fibrotic contraction in 2 eyes after primary IVR. Conclusion Preterm infants with type 1 ROP at > 40 weeks PMA displayed enhanced fibrotic proliferation. Both primary IVR and laser effectively promote ROP regression. Primary IVR cannot guarantee full retinal vascularization but is associated with a risk of fibrotic contraction.

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Section: Discussioncontrasting

confidence: 75%

Ranibizumab injection and laser photocoagulation to treat type 1 retinopathy of prematurity after 40 weeks post menstrual age: a retrospective case series study

et al. 2019

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“…Ranibizumab use is increasing due to systemic safety concerns (discussed below), but appears to have a higher rate of reactivation, ranging from 26% to 64% for ROP in general, not APROP. [2627282930313233] Moreover, Chuluunbat found an 18% rate of nonresponsiveness. [32] The lack of efficacy may be related to shorter half-life and therefore early reactivation.…”

Section: Discussionmentioning

confidence: 99%

Bevacizumab or laser for aggressive posterior retinopathy of prematurity

Blair

González

Snyder

et al. 2018

Taiwan J Ophthalmol

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PURPOSE:The purpose of this study was to report the rate of reactivation and structural outcome, after the laser or bevacizumab treatment for aggressive posterior retinopathy of prematurity (APROP).METHODS:Retrospective chart review was conducted on consecutive infants with APROP treated with (1) laser or (2) bevacizumab, followed by fluorescein angiography and prophylactic laser to the persistent avascular retina.RESULTS:Thirty-six eyes of 19 patients were included in this study. The mean gestational age was 24.5 weeks with a mean birth weight of 632 g in the bevacizumab group and 24.7 weeks and 777 g in the laser group. Unfavorable outcome occurred in 1 of 22 eyes treated with bevacizumab and in 5 of 14 eyes in the laser group (P = 0.002). Reactivation requiring treatment was common in both groups, 9/22 after bevacizumab and 6/14 after laser (ns).CONCLUSION:Regardless of the initial treatment reactivation requiring retreatment is common in eyes with APROP. The unfavorable structural outcome was significantly more common after initial laser treatment than after initial bevacizumab treatment.

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“…[33] However, the effect of anti-VEGF may be transient and there are increasing number of reports of late recurrences with anti-VEGF monotherapy. [343536] The present study included eyes with laser monotherapy only and combination with anti-VEGF could have potentially altered the outcome in some of the cases with zone 1 ROP. Posterior zone I ROP has been shown to have very poor outcome with laser alone and a combination treatment with anti-VEGF may be a better option in such eyes.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of 532 nm frequency-doubled Nd-YAG green laser photocoagulation for treatment of retinopathy of prematurity

Singh

Katoch

Handa

et al. 2019

Indian J Ophthalmol

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Purpose: To evaluate the safety and efficacy of 532 nm frequency-doubled Nd-YAG green laser for treatment of retinopathy of prematurity (ROP). Methods: This retrospective interventional case series included infants undergoing treatment for ROP with 532 nm green laser between January 2012 and March 2017 at a single tertiary-care referral center. Review of clinical records was done to identify baseline ROP characteristics, procedural difficulties, complications related to the laser procedure and outcome of treatment at ≥ 1 year of follow-up. Results: There are about 347 eyes of 182 infants were included in this present study. ROP presented in zone I in 76 eyes (21.9%) and zone II in 271 eyes (78.1%). Tunica vasculosa lentis (TVL) was present in 43.8% and pre-existing vitreous hemorrhage in 4.6% of the eyes. 532 nm green laser could be performed as a primary procedure in all eyes, including those with TVL. 322 eyes completed a minimum follow up of 1 year with a mean follow up of 22.8 months (range, 12–54 months). At the last follow-up visit, 298 (92.5%) of the 322 eyes had a favorable outcome. On logistic regression analysis, pre-existing fibrovascular proliferation ( p = 0.04) and new-onset fibrovascular proliferation after treatment ( p = 0.001) were the most significant independent predictors of poor outcome. Complications encountered were new-onset hemorrhage in 36 eyes (11.2%), anterior segment ischemia in two eyes (0.006%) and cataract in one eye (0.003%). Conclusion: 532 nm frequency-doubled Nd-YAG green laser appears to be safe and effective in the treatment of ROP.

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Recurrence of Retinopathy of Prematurity After Intravitreal Ranibizumab Monotherapy: Timing and Risk Factors

Abstract: Recurrence of type 1 ROP should be carefully watched in a long-term follow-up after IVR monotherapy, particularly in the first 12 weeks after IVR and for those with extensive retinal neovascularization or prolonged oxygen therapy.

Cited by 50 publications

References 29 publications

Ranibizumab injection and laser photocoagulation to treat type 1 retinopathy of prematurity after 40 weeks post menstrual age: a retrospective case series study

Ranibizumab injection and laser photocoagulation to treat type 1 retinopathy of prematurity after 40 weeks post menstrual age: a retrospective case series study

Bevacizumab or laser for aggressive posterior retinopathy of prematurity

Safety and efficacy of 532 nm frequency-doubled Nd-YAG green laser photocoagulation for treatment of retinopathy of prematurity

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