Retinopathy of Prematurity Growth Pattern after Anti-VEGF Treatment
Molly D. Scripture; Kathryn M. Haider, MD; Charline S. Boente, MD; Heather A. Smith, MD
University of Indiana
Introduction: The purpose of the study was to determine the typical growth patterns after intravitreal bevacizumab (IVB) injection for retinopathy of prematurity (ROP).
Methods: A retrospective chart review was performed on infants treated with IVB from 2010 to 2017. Demographic data, interventions, ophthalmologic exams, and outcomes were recorded.
Results: 39 patients (78 eyes) were identified. Improvement of plus disease was observed in 48/52 (92%) of eyes assessed at 1 day and 78/78 (100%) of eyes at 1-week post injection. Retinal vascular outgrowth into zone 2 was observed in 41%, 78%, 93%, and 100% of eyes at 2, 4, 6, and 9 weeks post injection, respectively. Vascular outgrowth into zone 3 was observed in 46%, 79%, 92%, and 100% of eyes at 10, 14, 18, and 23 weeks. A saw-toothed1 circumferential vessel at the leading margin of the vascular retina was noted in 53% of patients. Nineteen eyes had slow recurrence that was successfully treated with laser or additional IVB, average 9.6 weeks. Two eyes had rapid retinal detachment (10 and 30 weeks respectively) that occurred after reaching zone 3. Both had incomplete resolution of the ridge after IVB.
Discussion: Typical growth patterns after IVB are delayed and highly variable when compared to laser treatment2. Saw-toothed circumferential vessels can be cautiously observed. Incomplete ridge resolution may be a predictor of rapid retinal detachment.
Conclusion: The use of IVB for type 1 ROP has become increasingly popular. Understanding typical growth patterns can help practitioners anticipate patterns of growth and guide follow up.
References: 1. Padhi T, Das T, Rath S, Pradhan L, Sutar S, Panda K, Modi R, Jalali S. Serial evaluation of retinal vascular changes in infants treated with intravitreal bevacizumab for aggressive posterior retinopathy of prematurity in zone 1. Eye. 2016; 30(3):392-9.
2. Lepore D, Quinn G, Molle F, Baldascino A, Orazi L, Sammartino M, Purcaro V, Giannantonio C, Papacci P, Romagnoli C. Intravitreal Bevacizumab versus Laser Treatment in Type 1 Retinopathy of Prematurity Report on Fluorescein Angiographic Findings. Ophthalmology 2014;121:2212-9.