Retinopathy of Prematurity after Intravitreal Ranibizumab Monotherapy
Mariana A. Flores Pimentel, MD; Alejandra G. de Alba Campomanes, MD, MPH
University of California, San Francisco.
San Francisco, California, USA.
Introduction: Anti-VEGF agents are a treatment alternative for Type 1-ROP. Intravitreal ranibizumab(IVR), considered by some a safer alternative to bevacizumab, can result in ROP regression, with variable rates of disease recurrence. We describe a series of 9 consecutive Type 1-ROP eyes injected with IVR.
Methods: Retrospective chart review on consecutive infants treated with IVR for Type 1-ROP. Infants were followed for ROP until total resolution and/or complete vascularization. Follow-up was 75 to 116 weeks PMA. All patients had fundus photo-documentation(Retcam;Clarity Medical Systems, Inc.).
Results: 5 infants(9 eyes) underwent intravitreal injection of 0.25mg/0.025mL ranibizumab. 8 eyes had initial regression and 1 required an additional injection. Despite initial response, 5/9 eyes demonstrated reactivation or recurrence.Total regression was assured with additional laser treatment for 5 eyes that met Type 1 criteria again and 2 eyes for incomplete vascularization at 70 weeks PMA.Mean time between injection and additional treatment was 9 weeks(range 6-12). One patient was followed for Type 2-ROP until regression;at 107 weeks PMA both eyes had incomplete vascularization.
Discussion: It appears that treatment failure with ranibizumab monotherapy occurs at higher rates(0-83%) than with bevacizumab.There is a lack of consensus on what constitutes treatment failure, reactivation and recurrence as well as clear indications for when additional treatment is necessary.
Conclusion: In this series, all the eyes responded favorably to intravitreal ranibizumab followed by laser treatment. All patients required intensified and prolonged follow-up. Here we propose a classification system of ROP after IVR in an effort to create consensus on disease nomenclature and indications for adjuvant treatment.
References: 1. VanderVeen, D.K.; Melia, M.; Yang, M.B.; Hutchinson, A.K.; Wilson, L.B.; Lambert, S.R. Ophthalmic Technology Assessment. Anti-Vascular Endothelial Growth Factor Therapy for Primary Treatment of Type 1 Retinopathy of Prematurity. A Report by the American Academy of Ophthalmology. Ophthalmology, 2017. 124: 619-633
2. Chan, J.T.; Lam, C.P.S.; Kwok, M.K.M.; Wong, R.L.M.; Lee, G.K.Y.; Lau, W.W.Y.; Yam, J.C.S. Risk of recurrence of retinopathy of prematurity after initial intravitreal ranibizumab therapy. Nature. Scientific Reports, 2016. 6: 27082
3. Huang, Q.; Zhang, Q.; Fei, P.; Xu, Y.; Lyu, J.; Ji, X.; Peng, J.; Li, Y.; Zhao, P. Ranibizumab Injection as Primary Treatment in Patients with Retinopathy of Prematurity. Anatomic Outcomes and Influencing Factors. Ophthalmology, 2017. 124: 1156-1164