Intravitreal injection of bevacizumab (avastin) for treatment of stage 3 retinopathy of prematurity in zone I or posterior zone II

PURPOSE: To report a retrospective, consecutive, noncomparative case series of moderate and severe stage 3 retinopathy of prematurity (ROP) in zone I or posterior zone II treated by bilateral intravitreal injections of bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA). METHODS: Eleven infants weighing from 515 g to 1,015 g at birth (mean, 706.4 g) with gestational ages from 23 weeks to 28 weeks (mean, 24.3 weeks) received intravitreal injections of bevacizumab (0.625 mg [0.025 mL]) at 9.0 weeks to 15.0 weeks of age (mean, 11.0 weeks) and never had laser therapy. Length of follow-up was from 13.0 weeks to 85.0 weeks (mean, 48.5 weeks). RetCam photography (Clarity Medical Systems, Pleasanton, CA) was used to document preinjection retinal appearance and to follow postinjection retinal appearance. RESULTS: All 22 eyes were treated successfully (no retinal detachment, macular ectopia, high myopia, anisometropia, or other ocular abnormalities) with only 1 injection. No complications (local or systemic) were encountered. CONCLUSIONS: Intravitreal injection of bevacizumab was safe and effective in treating stage 3 ROP in zone I and posterior zone II in this small series of patients. A prospective, randomized, controlled, multicenter clinical trial has been initiated to investigate further this promising treatment.     

Diode laser photocoagulation for stage 3+ retinopathy of prematurity

Background: Laser photocoagulation in retinopathy of prematurity (ROP) appears to have fewer adverse effects than cryotherapy and seems to be at least as effective. Methods: To evaluate the efficacy and safety of diode laser photocoagulation, we included 42 eyes with stage 3+ ROP of 24 preterm infants (gestational age 24–29 weeks, mean ± SD 26.6 ± 1.3 weeks; birth weight 480–1400 g, 896 ± 196 g) in a prospective clinical study. Photocoagulation treatment was performed using a diode laser (810 nm) with a laser indirect ophthalmoscope delivery system. Follow-up ranged from 3 to 16 months (8.8 ± 4.0 months). Results: In 39 (93%) of 42 eyes ROP regressed after a single laser treatment and the outcome was a flat, attached retina. One eye (2%) had a second laser session and another eye (2%) had additional retinal detachment surgery, resulting in the regression of ROP and a flat, attached retina. Thus, the success rate was 41 (98%) out of 42 eyes. In one (2%) of the 42 eyes treatment failed and ROP progressed to stage 5, although additional retinal detachment surgery was performed. No adverse side effects of diode laser treatment were noticed except for a small amount of retinal/preretinal bleeding in the ridge in five eyes (12%) and a small postoperative anterior chamber hemorrhage in one eye (2%) with dense tunica vasculosa lentis. Neither lenticular opacities nor cataract formation were encountered. Conclusion: Diode laser photocoagulation for stage 3+ ROP showed only minor side effects and was at least as effective as cryotherapy treatment.     

Intravitreal bevacizumab for exudative retinal detachment post laser therapy for retinopathy of prematurity

Retinopathy of prematurity (ROP), a leading cause of pediatric blindness, predominantly affects premature and low-birth-weight infants. Although many cases are self-limiting, a minority progress to retinal detachment despite treatment. Exudative retinal detachments, although uncommon, have been reported after conventional laser therapy.^{1, 2 and 3} We report 2 cases of exudative retinal detachment after laser therapy for prethreshold and threshold ROP that responded favourably to a series of intravitreal bevacizumab injections.     

Intravitreal bevacizumab in aggressive posterior retinopathy of prematurity.

The anatomic response to intravitreal bevacizumab injection in three patients with aggressive, posterior retinopathy of prematurity is described. In all cases, the worse eye was treated with a single intravitreal injection of 0.75 mg of bevacizumab as monotherapy or complementary to laser therapy. In 24 hours, all injected eyes showed regression of the tunica vasculosa lentis and iris vessel engorgement and disappearance of iris rigidity. In addition, plus disease and retinal proliferation began to regress. None of the eyes required additional treatment. Follow-up of up to 10 months     

玻璃体内注射抗血管内皮生长因子药物治疗急进性后部型早产儿视网膜病变

目的 观察玻璃体内注射雷珠单抗(商品名Lucentis)治疗急进性后部型早产儿视网膜病变(aggressive posterior retinopathy of prematurity,AP-ROP)的疗效.方法 将自2014年3月至12月我院经广角照相系统(retcamⅢ)行ROP筛查后诊断为AP-ROP的26例36眼纳入研究.所有患眼均行玻璃体内注射雷珠单抗(0.05 mL)治疗,治疗后随访6个月,观察视网膜病变转归情况.结果 36眼中病变位于1区者20眼,病变位于2区者16眼;合并虹膜新生血管者2眼,合并玻璃体积血者10眼.玻璃体内注射雷珠单抗后,未见角膜水肿、晶状体混浊、眼内炎等眼部并发症及全身不良反应发生.行一次玻璃体内注射治愈者32眼,治愈率为88.89％.玻璃体内注射雷珠单抗后1周内,合并虹膜新生血管的2眼新生血管均消退.2眼发生牵引性视网膜脱离,行玻璃体切割术治疗.结论 玻璃体内注射雷珠单抗治疗AP-ROP安全、有效.     

Treating retinopathy of prematurity with laser diode photocoagulation

AIM: The purpose of the study was to assess the outcomes of the diode laser in the treatment of retinopathy of prematurity and to discuss the up-to-date possibilities of treating of active phase of this disease. MATERIAL AND METHODS: 96 children (185 eyes) treated with diode laser retinal photocoagulation for active stage 3 of ROP in our department in years 1996-2000. RESULTS: Favorable structural outcome was observed in 83.8% of treated eyes. In the remaining eyes the disease progressed despite of the treatment and falciform retinal fold (5.4%), partial retinal detachment (6.5%) and total retinal detachment (4.3%) developed. No serious complications were observed after the treatment. CONCLUSIONS: Diode laser retinal photocoagulation is a safe and effective procedure for treating active stage 3 of retinopathy of prematurity. It has been especially useful for treatment of changes in zone 1 and 2 of the disease. Diode laser photocoagulation is now the preferred method of treating active stage 3 of ROP in our department.     

Laser photocoagulation for stage 3+ retinopathy of prematurity

Twenty-two infants with "threshold" stage 3+ retinopathy of prematurity (ROP) were entered into a prospective, randomized clinical trial to compare the efficacy of transscleral cryotherapy versus laser photocoagulation delivered by the indirect ophthalmoscope. Eighteen infants have been followed for at least 3 months. Fifteen of 16 eyes randomized to laser and 9 of 12 eyes randomized to cryotherapy showed regression. The results suggest that laser therapy is as effective as cryotherapy in the treatment of ROP (P = 0.285).     

Intravitreal bevacizumab (Avastin) for post laser anterior segment ischemia in aggressive posterior retinopathy of prematurity

Aggressive posterior retinopathy of prematurity (formerly known as fulminate/type II/rush disease) occurs in zone 1 or posterior zone 2. Treatment involves extensive near confluent laser ablation of a large area of avascular retina. Anterior segment ischemia is a rare complication that can occur due to injury to the long posterior ciliary arteries in the horizontal meridians during aggressive posterior laser treatment. The outcome of this rare complication is very poor. This case describes a favorable outcome of intravitreal injection of bevacizumab (Avastin) in a case of anterior segment ischemia.     

Long-term refractive and biometric outcomes following diode laser therapy for retinopathy of prematurity.

PURPOSE: To assess the long-term refractive and biometric outcomes of diode laser-treated eyes in threshold retinopathy of prematurity (ROP). METHODS: Cycloplegic autorefraction and biometry (Zeiss IOLMaster) were performed, at a mean follow-up of 11 years, on 16 laser-treated eyes with threshold ROP and 9 comparison eyes with subthreshold untreated ROP. RESULTS: The laser-treated eyes had a mean spherical equivalent of -2.33 D with a mean astigmatic error of 1.38 D. The comparison eyes had a mean spherical equivalent of +1.07 D with a mean astigmatic error of 0.42 D. This trend toward increased myopia in treated eyes did not achieve statistical significance (p=0.08). The myopia in the laser group appeared to be slowly progressive in nature when compared with earlier refractive data for these patients. The laser-treated eyes had reduced anterior chamber depth (ACD) compared with the subthreshold eyes (p=0.02). When physiologic accommodation was inhibited by cycloplegic drops, the anterior chamber deepened by 0.13 mm in the laser-treated eyes and by 0.06 mm in the comparison eyes. This effect of accommodation on ACD did not differ significantly between the two groups (p=0.23). The laser-treated eyes and the comparison eyes did not differ significantly in terms of axial length, corneal power, corneal diameter, or lens power. However, both groups had steeper corneas, shallower anterior chambers, and shorter axial lengths when compared with historical full-term controls. CONCLUSIONS: Myopia in premature infants requiring laser treatment for ROP is associated with a shallowing of the anterior chamber and a steepening of the cornea. Physiological accommodation is not impaired by laser therapy or by severe ROP.     

Indirect diode laser treatment and cryotherapy in retinopathy of prematurity

Retinopathy of prematurity (ROP) is a major cause of blindness in babies. To explore the incidence, treatment and short-term outcome of the disease in Romania, a small scale study on 24 preterm infants with gestational age < 32 weeks and birthweight < 1500 g was undertaken. Gestational age was < 28 weeks in 66.6% and birthweight was < 1000 g in 70.8% of the children. The average age at the first examination with the indirect ophthalmoscope was 31.8 weeks, only two children having been seen at less than 6 weeks of age. 66.6% of the babies had ROP in various stages with 93.8% of these having bilateral (symmetrical or asymmetrical) abnormalities. 37.5% of the babies with ROP were in stage 5. 12.5% (2 patients) had bilateral threshold disease: one infant was treated with diode laser delivered with the laser indirect ophthalmoscope and the other with cryotherapy. In three eyes of these two infants the disease regressed. No major short term complications were noted and no second session of treatment was necessary. In our patients, the well-recognised correlation between the incidence and severity of the disease and gestational age and, to a lesser extent, birthweight was confirmed. Lack of equipment was the main reason for the delay in diagnosis. The extent of the disease in our patients, in a country where the number of surviving preterm babies is expected to increase in the coming years, warrants the initiation of a national screening programme for retinopathy of prematurity in Romania.     

Surgical therapy for stage V retinopathy of prematurity

Between February 1985 and February 1986, ten eyes from a larger series of infants operated on for stage V retinopathy of prematurity were seen with the open funnel type of retinal detachment and vascularly active eyes. We have developed a technique for these eyes involving two-step treatment. The first step is cryotherapy to the avascular peripheral retina which rarely detaches, even in stage V retinopathy of prematurity, followed by lensectomy, vitrectomy and membrane peeling. This technique has allowed us to operate on these ten eyes much earlier than would generally have been possible if the eyes were allowed to become vascularly inactive on their own. We were able to achieve anatomic reattachment of zone 1 as described in the International Classification of Retinopathy of Prematurity in 80% of these eyes. Light perception or better visual function was achieved in 70%, with 30% of the eyes capable of grasping brightly colored unlit objects of 1 in. (2.5 cm) in diameter. This represents a marked improvement in both anatomic and visual results. We feel that this improvement is due to the earlier treatment by lensectomy, vitrectomy and membrane peeling seemingly allowed by pretreating with cryotherapy. In addition, close attention was paid to the refractive status in visual stimulation during the post-operative period.Presented at the XVth Meeting of the Club Jules Gonin, Copenhagen, 10–15 August 1986     

Transscleral vs transpupillary diode laser photocoagulation for the treatment of zone II type 1 retinopathy of prematurity: Anatomical and refractive outcomes

Purpose:To compare the anatomical and refractive outcomes of transscleral diode versus transpupillary laser photocoagulation for the treatment of zone II type 1 retinopathy of prematurity (ROP).Methods:In this prospective comparative interventional case series, infants with type 1 ROP in zone II were assigned to either transpupillary or transscleral laser based on the surgeons’ expertise area. The rate of regression, need for retreatment, and structural and biometric outcomes at month 6 were evaluated and compared between the two treatment groups.Results:In total, 209 eyes were enrolled; 145 eyes of 77 infants and 64 eyes of 33 infants and were in transscleral and transpupillary groups, respectively. There was no significant difference in baseline characteristics between the groups. There was no significant difference in retreatment rates (1.6% vs. 3.4%; P = 0.669) and progression to stage 4 (1.6% vs. 2.8%; P = 0.999) between the transpupillary and transscleral groups, respectively. At month 6, the mean spherical equivalent was 0.31 ± 3.57 and 0.44 ± 2.85 diopters, and the axial length was 18.28 ± 6.22 and 18.36 ± 6.87 mm in the transpupillary and transscleral groups, respectively, without a significant difference between groups. There was no significant difference in the rate of myopia (43.8% vs. 33.8%; P = 0.169) and high myopia (4.7% vs. 4.8%; P = 0.965) in transpupillary and transscleral groups at month 6.Conclusion:The transpupillary and transscleral laser photocoagulation routes are both effective in the treatment of zone II type 1 ROP and show no significant differences in anatomical or refractive outcomes in relation to the route chosen.