Re-Treatment of Retinopathy of Prematurity after Primary Intravitreal Bevacizumab Montherapy
Youssef A. Helmy, MSc1; Ahmed R. Awadein, MD1; Dina H. Hassanein, MD1; Ahmed M. ElShewy, MD1; Ahmed I. Hegazy, MSc1; Sara M. ElWaraky, MSc1; Asmaa Shuaib, MSc1; Nancy A. Gomaa, MD2
1Pediatric Ophthalmology Department, Cairo University,Cairo,Egypt
2Department of Pediatrics,Cairo University,Cairo Egypt
Introduction: The efficacy of intravitreal Bevacizumab for the treatment of type 1 ROP , especially in zone 1 has been demonstrated by the BEAT-ROP study.1 Critics for using Anti-VEGF argue that the effects are transient and recurrences can occur.2 In this study we demonstrate the patterns of re-treatment after Primary Intravitreal Bevacizumab monotherapy for type 1 ROP in Cairo University hospitals.
Methods: A retrospective review of all infants who received intravitreal Bevacizumab as a primary treatment for Type 1 ROP and then required re-treatment from 2014 to 2017.
Results: Four out of 70 infants (5.7 %) required re-treatment. Three of the four patients initially had aggressive posterior ROP, and the 4th patient had stage 3 zone 2 with plus disease. The time of re-treatment in our patients was before 45 weeks of adjusted age. Their birth weights ranged from 900 g to 1800 g and their gestational ages ranged from 29 -32 weeks
Discussion: Our results are similar to those published by Mintz-Hittner et al in that the majority of re-treatment initially had AP-ROP however they are different in demonstrating that re-treatment doesn’t necessarily occur in very low birth weight infants and that it could occur earlier than then 45-55 weeks of adjusted age that had been described by Mintz-Hittner et al. 3
Conclusion: The use of Bevacizumab monotherapy should be undertaken with a strict follow up regimen. The risks for recurrences , reactivation or failure should be kept in mind, and the presence of skilled surgeons for rescue laser or vitrectomy is a must for any comprehensive ROP service.
References: 1- Mintz-Hittner HA, Kennedy KA , Chuang AZ & BEAT-ROP Cooperative Group. Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity. N Engl J Med. 2011 Feb 17;364(7):603-15.
2- Hajrasouliha AR; Garcia-Gonzales JM, Shapiro MJ, Yoon H; Blair MP Reactivation of Retinopathy of Prematurity Three Years After Treatment With Bevacizumab.Ophthalmic Surgery, Lasers & Imaging Retina. 2017 Mar.48(3):255-259. DOI: 10.3928/23258160-20170301-10
3- Mintz-Hittner HA, Geloneck MM ,Chuang AZ. Clinical Management of Recurrent Retinopathy of Prematurity after Intravitreal Bevacizumab Monotherapy.Ophthalmology. 2016 Sep;123(9):1845-55
Acknowledgements: Hala M. ElHilali, MD, Alia A. Ali , MD and Huda H.Al-Hayouti , FRCS for their efforts in the screening of ROP in Cairo University , and Mariam El-Fiky ,FRCS for her help in acquiring follow up images