Ultra-low-dose intravitreal bevacizumab for the treatment of retinopathy of prematurity: a case series

Hillier, Roxane J.; Connor, Alan; Shafiq, Ayad

doi:10.1136/bjophthalmol-2017-310408

Cited by 22 publications

(11 citation statements)

References 19 publications

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“…Hillier et al . have reported more favorable outcomes for IVB treated with 0.16 mg 25 . Moreover, Wallace DK found that a dosage of bevacizumab as low as 0.031 mg, 5%of the dosage used in the BEAT-ROP trial, was effective in 9 of 9 eyes 26 .…”

Section: Discussionmentioning

confidence: 96%

A lower dose of intravitreal conbercept effectively treats retinopathy of prematurity

Cheng

Meng

Linghu

et al. 2018

Sci Rep

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Intravitreal Conbercept (IVC) is the latest applied and effective treatment for the management of retinopathy of prematurity (ROP). However, conbercept escapes from the vitreous into the general circulation and reduce systemic VEGF concentrations. Thus, there are concerns about systemic complications, in these premature infants who are developing vital organ systems. This study is to determine whether a low dosage (0.15 mg/0.015 mL) of IVC is effective in the treatment of Zone II Stage 2/3 + ROP. A total of 38 eyes of 20 infants were analyzed retrospectively. We identified treatment effectiveness as complete regression of retinopathy and retinal vascularisation to zone III. The mean gestational age (GA), postmenstrual age (PMA) at treatment and birth weights (BW) were 28.6 ± 2.2 weeks, 39.3 ± 3.0 weeks and 1297.5 ± 429.2 g respectively. Primary effectiveness (react to IVC 0.15 mg alone) was found in 32/38 eyes (84.2%). Secondary effectiveness (a second IVC was required) was found in 6/38 eyes (15.8%). Follow-up continued until 90 weeks’ postmenstrual age and showed no recurrences of plus disease or neovascularization. The study suggests 0.15 mg IVC is effective for Zone II Stage 2/3 + ROP, and there is no adverse ocular outcomes during the follow-up period.

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Section: Discussionmentioning

confidence: 96%

A lower dose of intravitreal conbercept effectively treats retinopathy of prematurity

Cheng

Meng

Linghu

et al. 2018

Sci Rep

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“…[24] Hillier and Sahin et al , on the other hand, used low dosages of İVB (0.16 mg and 0.0625 mg), a strategy which led them to find that low-dosage IVB is an effective treatment for severe ROP. [2526]…”

Section: Discussionmentioning

confidence: 99%

The safety and effectiveness of 0.16 mg bevacizumab plus or minus additional laser photocoagulation in the treatment of retinopathy of prematurity

Akdogan

Çevik

Şahin

2019

Indian J Ophthalmol

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Purpose: Retinopathy of prematurity (ROP) is the leading cause of preventable blindness in premature infants. Antivascular endothelial growth factor (anti-VEGF) therapy has been used increasingly in treatment as a pharmacological alternative to laser therapy. In this study, we evaluate the results of low-dose anti-VEGF treatments. Methods: Design: Retrospective--observational study. Infants who had been evaluated for ROP disease between February 2016 and February 2017 were assessed. We retrospectively reviewed the ROP stages, treatment results, and complications. Laser photocoagulation (LPC) and intravitreal bevacizumab (0.16 mg IVB) were used for treatment and fundus fluorescein angiography (FFA) was also performed in some of the cases. Results: IVB was applied to 43 infants. A macular hole was seen in one infant's eye after IVB. LPC was applied to avascular areas in 21 infants. In three patients, persistence of the disease was observed after administration of a low dose of IVB. Additional LFK was performed in these patients. None of the infants who received LPC had any complications. Conclusion: IVB is increasingly becoming the first-line treatment for ROP. For severe ROP, 0.16 mg IVB is effective. Using LPC to treat avascular areas after 70 weeks’ gestational age (GA) may decrease the risk of late recurrence and appears to be a safe treatment to use.

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“…This dose has been effective in treating ROP and reported in several case series for ROP treatment 5–7. This systemic absorption is at the heart of developmental concerns because of VEGF suppression 1.…”

Section: Discussionmentioning

confidence: 99%

Contralateral effect of systemic absorption of low dose bevacizumab (Avastin) after unilateral intravitreal injection in severe retinopathy of prematurity (ROP)

2020

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An extremely premature baby boy born at 23 weeks’ gestational age was treated with unilateral low dose of 0.16 mg/0.025 mL intravitreal bevacizumab in the left eye for aggressive retinopathy of prematurity (ROP). He developed photographically documented changes in his contralateral right eye on imaging 5 days later. Second eye treatment was at 12 days. He has development assessment and ophthalmic review beyond age 2, which is normal. Systemic absorption of the drug caused an end organ effect to slow down and reverse ROP in his untreated right eye. Both eyes vascularised fully. His normal Bayley III developmental score at age 2 is uncommon for a 23-week gestation baby. Even at a low dose, bevacizumab has the potential for end organ effect on the second eye, and therefore other organs. In this case, there are no medium-term measurable neurodevelopmental side-effects. We suggest longer term follow-up is required before excluding unwanted side-effects.

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Ultra-low-dose intravitreal bevacizumab for the treatment of retinopathy of prematurity: a case series

Abstract: 0.16 mg IVB is effective in the treatment of severe and posterior ROP, with no adverse ocular outcomes occurring in our series.

Cited by 22 publications

References 19 publications

A lower dose of intravitreal conbercept effectively treats retinopathy of prematurity

A lower dose of intravitreal conbercept effectively treats retinopathy of prematurity

The safety and effectiveness of 0.16 mg bevacizumab plus or minus additional laser photocoagulation in the treatment of retinopathy of prematurity

Contralateral effect of systemic absorption of low dose bevacizumab (Avastin) after unilateral intravitreal injection in severe retinopathy of prematurity (ROP)

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