Very Late Reactivation of Retinopathy of Prematurity After Monotherapy With Intravitreal Bevacizumab

Abstract

The authors report a case of very late reactivation of retinopathy of prematurity (ROP) after bevacizumab monotherapy. A female born at 630 g and 24 weeks received two bilateral treatment of bevacizumab (Avastin; Genentech, South San Francisco, CA) for aggressive posterior ROP (APROP). At 2.5 years of age, ROP reactivated in the form of tractional retinal detachment in one eye and milder reactivation in the other. Although intravitreal bevacizumab treatment is effective in inducing regression of ROP, late reactivation and retinal detachments can occur after initial extended quiescence. Due to alterations of disease progression after bevacizumab, close follow-up by peripheral fluorescein angiography and laser ablation of persistent avascular retina is recommended to prevent disease reactivation and progression to retinal detachment.

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

“…5,14,16 Thus, a follow-up to at least 70 weeks' PMA until complete involution of ROP with vascularization of zone III was recommended for patients treated with IVB monotherapy. 16 Although there were single case reports 22,23 of very late ROP recurrence after IVB monotherapy or repeated injections, lack of frequent observations in eyes with persistent avascularity in peripheral zone II and zone III after IVB would account for the unfavorable outcomes. Our study also recommends a post-IVR follow-up until complete involution of ROP with vascularization of zone III to observe any possible recurrence, and the length of follow-up should be tailored according to individual response to IVR treatment.…”

Treatment of type I ROP with intravitreal bevacizumab or laser photocoagulation according to retinal zone

“…Gene defects causing FEVR have also been detected in some patients with ROP suggesting that these disorders might share certain mechanisms regarding regulation and maturation of the retinal vascularisation and remodelling of the capillary network 21 22. This observation may explain late recurrences up to 2½ years after primary IVB therapy for ROP 16 23…”

Advances in understanding and management of retinopathy of prematurity

“…(89, 115, 144, 170, 195) It is difficult to modulate the dose of VEGF inhibition in the individual preterm infant eye. One dose of bevacizumab, an anti-VEGF agent, led to persistent avascular retina and recurrent disease (85, 160), even 2.5 years later. (160–163, 166–168) (2, 10, 64, 67, 83, 149, 166) (2, 10, 64, 67, 83, 149, 166) (2, 10, 64, 67, 83, 149, 166) (2, 10, 64, 67, 83, 149, 166) (2, 10, 64, 67, 83, 149, 166) (2, 10, 64, 67, 83, 149, 166) (2, 10, 64, 67, 83, 149, 166) (2, 10, 64, 67, 83, 149, 166) (2, 10, 64, 67, 83, 149, 166) The direct comparison of anti-VEGF treatment between premature infant and adult eyes also suggests that ¼ the dose in vitreous in the infant eye would still be much less diluted in the many fold smaller infant blood volume compared to the adult.…”