Risk of recurrence of retinopathy of prematurity after initial intravitreal ranibizumab therapy

Abstract

We report our experience with the use of intravitreal ranibizumab for the treatment of retinopathy of prematurity (ROP). A retrospective review was performed on 138 consecutive infants screened at a single centre over 18 months. Intravitreal ranibizumab was offered in selected cases requiring treatment, such as aggressive posterior ROP or poor mydriasis. 2 eyes of 1 infant received intravitreal ranibizumab alone and 8 eyes of 5 infants received combined intravitreal ranibizumab and laser therapy. 3 out of 8 eyes treated initially with intravitreal ranibizumab monotherapy had persistent disease requiring laser therapy, and 3 out of 5 eyes with initial regression suffered disease recurrence at a mean of 7.6 weeks post-injection. 2 eyes treated first with laser followed by intravitreal ranibizumab had disease regression without recurrence. Our cohort demonstrate a significant rate of persistent disease and recurrence in ROP eyes treated initially with intravitreal ranibizumab monotherapy, which is greater and earlier than that reported for intravitreal bevacizumab in the BEAT-ROP study. Intravitreal ranibizumab may be useful as an initial treatment in selected cases of ROP when laser therapy as first line is suboptimal. However, close monitoring is important and adjunctive laser therapy may subsequently be needed in a majority of cases.

Combination of Intravitreal Injection of Ranibizumab and Photocoagulation for the Treatment of Aggressive Posterior Retinopathy of Prematurity with Vitreous Hemorrhage

“…The reason of the lower rate of adequate regression and higher rate of recurrence of ROP after monotherapy of IVR in our study may probably be due to the fact that the patients we enrolled were more severe than other studies. But the recurrence time in our study ranged from 4 weeks to 10 weeks, which is quite similar to the other studies [18, 21]. Therefore, it seems that monotherapy of IVR is not sufficient in treating severe type ROP, such as AP-ROP associated with hemorrhage in particular.…”

Comparison of Bevacizumab and Ranibizumab in the Treatment of Type 1 Retinopathy of Prematurity Affecting Zone 1

“…There are several studies which showed the effects of different treatment options like laser photocoagulation, intravitreal bevacizumab (IVB), and intravitreal ranibizumab (IVR) for type 1 ROP [13][14][15][16][17][18][19]. However, there are few studies which compared the effects of IVB and IVR in the treatment of type 1 ROP affecting zone 1.…”

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

“…10,12,13 Recurrence of extraretinal fibrovascular proliferation (EFP) after a single treatment of an anti-VEGF agent, either with bevacizumab or ranibizumab, was reported in type 1 ROP, possibly resulting macular dragging or retinal detachment. 5,[14][15][16][17][18] Therefore, timely detection as well as management of recurrence has become a major concern in anti-VEGF therapy for ROP. There is a scarcity of evidence to guide clinicians on the time course of recurrence, major risk time, time-related characteristics, length of follow-up, and risk factors for ROP recurrence after intravitreal ranibizumab (IVR) monotherapy.…”