Retinal Detachment Despite Aggressive Management of Aggressive Posterior Retinopathy of Prematurity

Abstract

Posterior retinopathy of prematurity (ROP) is unusual in its atypical features and its aggressive, rapidly progressive course. It is more difficult to recognize and to treat, with many of these eyes progressing to retinal detachment despite multiple treatments with laser or cryotherapy. The authors present a case of aggressive posterior ROP refractory to multiple laser treatment. This patient was successfully treated with intravitreal bevacizumab, but required repeat treatment 4 months later. The second injection with bevacizumab was followed by progression to retinal detachment requiring surgery. The patient remains stable after surgery.

Evaluation of 2-year outcomes following intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity

“…These studies demonstrated laser photocoagulation results in better anatomic results and causes lower de grees of myopia than cryoablation (17)(18)(19) . However, laser treatment for APROP has been shown to be associated with a range of unfavora ble anatomic and functional outcomes depending on disease severity (2,3,20) . The introduction of IVB to ROP therapy has allowed the majority of cases of APROP to be salvaged with successful anatomic outcomes (6,9,21) .…”

Serious adverse events and visual outcomes of rescue therapy using adjunct bevacizumab to laser and surgery for retinopathy of prematurity. The Indian Twin Cities Retinopathy of Prematurity Screening database Report number 5

“…Sometimes, due to systemic comorbidities, babies may be unfit for general anaesthesia for the scheduled surgery 3–7 days postinjection, and this delay can result in progressive traction and fibrotic reaction. Increased traction has been reported in adults and in ROP, postulated to be due to a rapid regression and contraction of active fibrovascular fronds, especially when there is some pre-existing traction 20 21. It is understood that anti-VEGF drugs can only regress the vascular component of ROP, while the fibrovascular component does not have VEGF-related growth and, hence, this tractional component can be ongoing and indeed gets aggravated due to rapid regression of vasculature within the fibrovascular component 12 20 21…”

Delayed onset atypical vitreoretinal traction band formation after an intravitreal injection of bevacizumab in stage 3 retinopathy of prematurity

“…5,7,8,13 To our best knowledge, only two cases have been reported who showed delayed onset retinal detachment, which occurred 4 months after anti-VEGF treatment. 15,16 Among those patients the TRD started from the EFP, which was located at the margin of vascularized and non-vascularized retina without exception. We experienced the development of atypical fibrous traction band, some of which lead to TRD in active stage 3 ROP patients who were treated with intravitreal injection of bevacizumab.…”