Retinopathy of Prematurity Reactivated 28 Months after Injection of Ranibizumab

Ji, Marco H.; Moshfeghi, Darius M.; Callaway, Natalia F.; Bodnar, Zachary; Schachar, Ira H.; Amorelli, Giulia Maria; Orazi, Lorenzo; Molle, Fernando; Lepore, Domenico

doi:10.1016/j.oret.2019.06.017

Cited by 9 publications

(12 citation statements)

References 6 publications

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“…11 Reactivations can occur even years after the primary treatment and in the literature they have been reported as late as 3 years for IVB 12 and 2.5 years for IVR. 10 Even though off-label anti-VEGF is widely used for ROP, current guidelines do not clearly address the management after injection. The last joint statement screening guidelines for ROP elaborated by the American Academy of Ophthalmology (AAO) in conjunction with the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), the American Academy of Pediatrics (AAP), and the American Association of Certified Orthoptists (AACO) highlighted the need of follow-up without specifying the modality and the need for retreatment with laser.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Recently, the RAnibizumab Compared With Laser Therapy for the Treatment of INfants BOrn Prematurely With Retinopathy of Prematurity (RAINBOW) trial demonstrated efficacy of 0.2 mg intravitreal ranibizumab (IVR) for treatment of ROP. 9 Despite this, Anti-VEGF has a higher risk of recurrence even after 1 year compared to laser [10][11][12] ; thus, it requires longer and more extended follow-up after treatment. Anti-VEGF injections may allow vascularization to extend further into the retinal periphery than laser, but it is common to have persistence of peripheral avascular retina leading to peripheral ischemia and/or reactivation.…”

Section: Introductionmentioning

confidence: 99%

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Conserved regression patterns of retinopathy of prematurity after intravitreal ranibizumab: A class effect

Moshfeghi

Shields

et al. 2020

European Journal of Ophthalmology

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Purpose: To determine if fluorescein angiographic (FA) findings after intravitreal ranibizumab (IVR) for retinopathy of prematurity (ROP) conform to a class effect previously described with bevacizumab. Methods: Single-center retrospective case series of all infants treated with 0.2 mg (0.02 mL) IVR for Type 1 ROP from July 2016 to November 2018. FA were obtained at 40, 52, 62, and 72 weeks of postmenstrual age (PMA) using wide-angle photography. FA images were analyzed and the peripheral avascular areas measured with ImageJ using a reference disc diameter (DD). Based on the extent of the avascular area and tortuosity of the retinal vessels all eyes were classified into four categories: complete vascular maturity (vascularization within 2 DD of the ora serrata), VAA (avascular area >2 DD of the ora serrata), VAT (avascular area >2 DD of the ora serrata and posterior tortuosity), and reactivation (recurrence of stage disease). Results: About 13 infants were enrolled and 24 eyes were available in this study. None of the eyes reached complete vascular maturity at an average PMA of 60 weeks, 7 (29%) eyes presented with VAA, 8 (33%) with VAT, and 9 (37.5%) reactivated. The reactivated eyes presented with the largest area of peripheral ischemia, followed by the VAT and then the VAA groups ( p = 0.02). Conclusion: IVR conforms to the previously described regression patterns following intravitreal bevacizumab for ROP indicative of a class effect. Follow-up using FA might help to optimize the management of these infants after injection of the drug.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Conserved regression patterns of retinopathy of prematurity after intravitreal ranibizumab: A class effect

Moshfeghi

Shields

et al. 2020

European Journal of Ophthalmology

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“…15 This and many other reports showed that the use of FA might play a paramount role in the long-term followup management of babies treated with antivascular endothelial growth factor (VEGF) agents. [15][16][17][18] Furthermore, it is putative that information obtained using FA may provide greater understanding of subtleties of acute-phase ROP. 14,19,20 We hypothesized that FA images could be a potential dataset to train a DL algorithm to detect ROP cases requiring treatment.…”

Section: Discussionmentioning

confidence: 99%

Convolutional Neural Network Based on Fluorescein Angiography Images for Retinopathy of Prematurity Management

Lepore

Pagliara

et al. 2020

Trans. Vis. Sci. Tech.

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The purpose of this study was to explore the use of fluorescein angiography (FA) images in a convolutional neural network (CNN) in the management of retinopathy of prematurity (ROP). Methods: The dataset involved a total of 835 FA images of 149 eyes (90 patients), where each eye was associated with a binary outcome (57 "untreated" eyes and 92 "treated"; 308 "untreated" images, 527 "treated"). The resolution of the images was 1600 and 1200 px in 20% of cases, whereas the remaining 80% had a resolution of 640 and 480 px. All the images were resized to 640 and 480 px before training and no other preprocessing was applied. A CNN with four convolutional layers was trained on 90% of the images (n = 752) randomly chosen. The accuracy of the prediction was assessed on the remaining 10% of images (n = 83). Keras version 2.2.0 for R with Tensorflow backend version 1.11.0 was used for the analysis. Results: The validation accuracy after 100 epochs was 0.88, whereas training accuracy was 0.97. The receiver operating characteristic (ROC) presented an area under the curve (AUC) of 0.91. Conclusions: Our study showed, we believe for the first time, the applicability of artificial intelligence (CNN) technology in the ROP management driven by FA. Further studies are needed to exploit different fields of applications of this technology. Translational Relevance: This algorithm is the basis for a system that could be applied to both ROP as well as experimental oxygen induced retinopathy.

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“…7 With the recent shift to anti-VEGF therapy for ROP treatment, we reviewed our experience with telemedicine monitoring of post-anti-VEGF treated patients. In contrast to laser, injection of anti-VEGFs changes the natural history of ROP and requires continued surveillance for a longer interval to detect promptly recurrences or reactivations of disease that may occur even years after injection, 8,9 with the highest risk between postmenstrual age 45 to 55 weeks. 6 Reactivations or recurrences of ROP, if untreated, may progress to tractional retinal detachment despite early regression of the disease.…”

Section: Introductionmentioning

confidence: 99%

<p>Telemedicine Follow-Up for Intravitreal Bevacizumab Injection in the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) Cohort</p>

Callaway

Greven³

et al. 2020

OPTH

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Telemedicine has emerged as a potential solution to face the disproportion between infants that need to be screened for retinopathy of prematurity (ROP) and the lack of ophthalmologists. We evaluated its utility in the follow-up after off-label intravitreal injection of bevacizumab. None of the treated infants ended up with bad anatomic outcome. Telemedicine is an alternative safe method to monitor patients after treatment.

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Retinopathy of Prematurity Reactivated 28 Months after Injection of Ranibizumab

Cited by 9 publications

References 6 publications

Conserved regression patterns of retinopathy of prematurity after intravitreal ranibizumab: A class effect

Conserved regression patterns of retinopathy of prematurity after intravitreal ranibizumab: A class effect

Convolutional Neural Network Based on Fluorescein Angiography Images for Retinopathy of Prematurity Management

<p>Telemedicine Follow-Up for Intravitreal Bevacizumab Injection in the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) Cohort</p>

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