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.     

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.     

Intravitreal injection of bevacizumab for retinopathy of prematurity

Purpose

To evaluate the outcomes of intravitreal injection of bevacizumab (IVB) for retinopathy of prematurity (ROP).

Methods

IVB was selected to be the first treatment for type 1 ROP in 8 eyes (4 patients). Bevacizumab (0.25 mg/eye) was injected into the vitreous cavity under either general anesthesia or sedation. Fundus photography and fluorescein angiography were performed before the IVB. One infant was observed to the age of 1 year 6 months, the second to 1 year 9 months, the third to 1 year 10 months, and the fourth to 2 years 0 month.

Results

Before the IVB, 6 eyes (3 patients) had ROP in zone II and 2 eyes (one patient) had ROP in zone I. The 3 infants with ROP in zone II weighed 652, 476, and 579 g with gestational ages of 24, 27, and 24 weeks at birth, respectively. The infant with ROP in zone I weighed 972 g with a gestational age of 26 weeks at birth. IVB was performed at postmenstrual ages of 33–37 weeks. The IVB was effective in all eyes with ROP in zone II and additional treatment was not required, whereas vitreous hemorrhage and cataract were found at 19 weeks and 5 months after the initial IVB in the two eyes with ROP in zone I. These two eyes required additional IVB, laser photocoagulation, and surgery.

Conclusions

Our findings suggest that eyes with type 1 ROP in zone II can be treated with IVB. Further studies are needed with a larger number of eyes.     

Intravitreal bevacizumab in retinopathy of prematurity: an interventional case series

Background  

To evaluate the results of intravitreal bevacizumab in terms of regression of retinopathy of prematurity (ROP).     

急性进展性后部型早产儿视网膜病变的治疗研究进展

急性进展性后部型早产儿视网膜病变(aggressive posterior retinopathy of prematurity,AP-ROP)是一种少见且进展很快的严重性早产儿视网膜病变,可不遵循1~3期的经典病程,而迅速进展为5期病变,最终导致不可逆的视力丧失。目前常用的治疗方式有激光光凝、玻璃体腔内注射抗血管内皮生长因子(VEGF)、玻璃体切除术。本文将从以上三个方面入手,对AP-ROP的治疗方式进行综述。     

Early vitreous surgery for aggressive posterior retinopathy of prematurity

PURPOSE: To assess the efficacy of early vitrectomy for aggressive posterior retinopathy of prematurity (ROP) to stop progression of retinal detachment. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: Twenty-two eyes (15 patients) with aggressive posterior ROP underwent vitrectomy with or without lens sparing, because retinal photocoagulation failed to stop progression of fibrovascular proliferation, despite being performed early, densely, and with early retreatment. We assessed the status of retinal attachment and foveal formation ophthalmoscopically and the presence or absence of fixation of visual behavior. RESULTS: Follow-up ranged from six to 12 months (mean, 9 months). Six eyes (100%) in which a lens-sparing vitrectomy was performed developed a large tractional retinal detachment. In contrast, the retinas were completely reattached in 16 eyes (100%) in which vitrectomy with lensectomy was performed, nine eyes (56%) had foveal configuration, and 14 eyes (88%) had steady fixation. CONCLUSIONS: These results suggest that early vitrectomy is effective for preventing retinal detachment in aggressive posterior ROP.     

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.     

Adjunctive effect of intravitreal bevacizumab prior to lens-sparing vitrectomy in aggressive posterior retinopathy of prematurity: a case report

Background  

Intravitreal injection of bevacizumab in retinopathy of prematurity has shown satisfactory results without any systemic complications. However, increased fibrosis and tissue contraction are reported as adverse effects in some cases.     

Intravitreal bevacizumab treatment reduces ocular blood flow in retinopathy of prematurity: a four-case report

Graefe's Archive for Clinical and Experimental Ophthalmology - To evaluate the relationship between ocular blood flow, expressed as mean blur rate (MBR) by laser speckle flowgraphy, and...     

Pattern retinal laser coagulation in treatment of aggressive posterior retinopathy of prematurity

Efficacy of pattern scanning laser coagulation in treatment of aggressive posterior retinopathy of prematurity (ROP) was evaluated. 25 premature neonates (50 eyes) with aggressive posterior ROP were examined and divided into two groups. 13 infants (26 eyes) of the 1st group underwent pattern laser coagulation performed using automanual scanning laser ophthalmologic coagulator. In the 2nd group diod laser coagulation was performed using conventional "point-by-point" technique in 12 infants (24 eyes). Post OP follow-up was 3-6 months. The average duration of laser coagulation session was 15 min in the 1st and 40 min in the 2nd group. The pattern of clinical regression was similar in both groups. In the Ist group stationary regression of aggressive posterior ROP was achieved in 77% patients. The clinical efficacy of treatment in the 2nd group was 71%. Pattern scanning laser coagulation in treatment of aggressive posterior ROP significantly allows to reduce duration of treatment session and narcosis of premature infant, improve efficacy and safety of laser procedure.     

急进性后部型早产儿视网膜病变的临床特征及治疗

目的 观察急进性后部型早产儿视网膜病变（AP-ROP）的临床特征和治疗效果。 方法回顾分析18例AP-ROP患儿35只眼的临床资料。暗室条件下,采用双目间接检眼镜配合28 D透镜、巩膜压迫器、广角数码视网膜成像系统(RetCam)检查所有患儿视网膜并记录病变。所有患儿在确诊后12 h内,采用半导体倍频532 nm波长激光,应用双目间接检眼镜激光输出系统对病变周边部视网膜无血管区进行激光光凝。其中,因激光光凝治疗后病变继续进展再行玻璃体手术治疗者13只眼,占37.1%;单纯行激光光凝治疗者22只眼,占62.9%。治疗后随访6个月~5年,平均随访时间为23.5个月。观察视网膜病变的转归。结果 所有患眼均为后极部病变,位于1区或2区的后部。4个象限的视网膜血管高度扩张纡曲,难以区分视网膜小动静脉,出现视网膜内血管短路、动静脉弓;视网膜无血管区和血管化区域边界不清,新生血管网呈扁平形态,不易识别;无明显的分界线或嵴等典型病变形成。单纯行激光光凝治疗的22只眼,治疗后血管形态及走向趋于正常,病变消退,无血管区光凝斑均匀覆盖。行玻璃体切割手术的13只眼,激光光凝治疗后玻璃体在后极部环形增生收缩引起牵拉性视网膜脱离。手术治疗后视网膜复位8只眼;玻璃体渗出及出血,视网膜未复位5只眼。结论 AP-ROP临床表现特殊。及时激光光凝治疗可使大部分患眼病变消退。激光光凝治疗后病变继续进展者行早期玻璃体手术干预,可使大部分患眼视网膜复位。     

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.     

Serial evaluation of retinal vascular changes in infants treated with intravitreal bevacizumab for aggressive posterior retinopathy of prematurity in zone I

Purpose

To evaluate the serial changes in retinal vasculature in infants treated with intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity (APROP) in zone I.

Methods

Retrospective analysis of serial changes in retinal vasculature after IVB in the seven eyes of four babies with APROP in zone I.

Results

The initial regression, following IVB, was dramatic with reduction in vessel caliber and marked thinning and invisibility of the bridging shunts. Resurgent vascular development was very slow radially though there was continued abnormal vascular growth circumferentially. Common findings in all eyes were tangled vasculature and fine saw-toothed shunts. The variable findings were (1) new closely packed multilayered bridging shunts, long arching mature looking vessels, and finally a ridge at the periphery (n=3 eyes) at 52 weeks of postmenstrual age (PMA); (2) status quo at the stage of saw-toothed shunt and ridge in both eyes for a long time (n=2 eyes); and (3) multiple retinal hemorrhages within the vascularized retina and thick preretinal hemorrhage overlying the saw-toothed shunts and ridge that persisted for another 3 weeks and regressed 2 weeks after laser (n=1). The eyes that received bevacizumab alone (3) did not show any abnormal vascularization at 56 weeks of PMA or beyond.

Conclusions

The retinal vascularization following IVB was different than normal in terms of its time, speed, and morphology; few of these changes are first to be reported in the literature (Medline search) and warrants further studies.