Fluorescein Angiography Findings in Infants Treated With Intravitreal Bevacizumab for Retinopathy of Prematurity
Sasha A. Mansukhani, MBBS, MS, FICO; G. B. Hubbard, MD; Rebecca Neustein, MD; Joseph Schertzer; John C. Allen, MD; Amy K. Hutchinson, MD
Introduction: Medium and long term sequelae of intravitreal bevacizumab (IVB) for type 1 retinopathy of prematurity (ROP) are uncertain.
Methods: We reviewed records of consecutive patients undergoing fluorescein angiography (FA) after treatment with IVB for type 1 ROP between January 1st 2013 and June 31st 2017. FA was performed for incomplete vascularization or recurrent stage 3 ROP. Angiograms were reviewed for occult neovascularization (NV) and abnormal vascular patterns.
Results: Twenty-six eyes of 13 infants were included. Gestational age ranged from 22.7-26.4 weeks (24.4 ± 1.2;mean ± SD). Birth weight ranged from 510-1025g (686.2 ± 170.1; mean ± SD). Mean post-menstrual age at the time of IVB and FA was 35.5 ± 1.9 and 67.2 ± 13.7 weeks respectively. Review of angiograms revealed arrest of vascular development in zone 2 in 84.6% and occult NV in 29.2% of eyes. Abnormal vascular patterns seen at the vascular-avascular junction included blunted vessel terminals (84.6%) and circumferential shunts (7.7%). An unusual pattern of two circumferential rows of blunted vessel terminals (‘double blunted vessel pattern’) was also noted (11.5%). Posterior to the junction, shunts were seen in 73.1%. Macular abnormalities were seen in 46.2%. All but 2 eyes received laser treatment following FA.
Discussion: FA after bevacizumab injection for type 1 ROP may reveal subclinical NV and abnormal or incomplete vascularization. We recommend laser treatment for patients with NV or arrest of vascular development in zone 2. The significance of other abnormal vascular patterns is unknown.1
Conclusion: Abnormal FA findings are common after IVB for ROP. Implications for long term vision are unclear.
References: 1. Tahija SG, Hersetyati R, Lam GC, Kusaka S, McMenamin PG. Fluorescein angiographic observations of peripheral retinal vessel growth in infants after intravitreal injection of bevacizumab as sole therapy for zone I and posterior zone II retinopathy of prematurity. Br J Ophthalmol. 2014 Apr;98(4):507-12.