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Ophthalmology. 2016 Sep;123(9):1845-55. doi: 10.1016/j.ophtha.2016.04.028. Epub 2016 May 27.

Clinical Management of Recurrent Retinopathy of Prematurity after Intravitreal Bevacizumab Monotherapy.

Author information

1
Ruiz Department of Ophthalmology and Visual Science, The University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, Texas; W. T. & Louise J. Moran Pediatric Eye Clinic, Robert Cizik Eye Clinic, Houston, Texas. Electronic address: Helen.A.Mintz-Hittner@uth.tmc.edu.
2
Ruiz Department of Ophthalmology and Visual Science, The University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, Texas; W. T. & Louise J. Moran Pediatric Eye Clinic, Robert Cizik Eye Clinic, Houston, Texas.
3
Ruiz Department of Ophthalmology and Visual Science, The University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, Texas.

Abstract

PURPOSE:

To determine incidence, risk factors, risk period, and characteristics of recurrent retinopathy of prematurity (ROP) treated by intravitreal bevacizumab (IVB) monotherapy.

DESIGN:

Retrospective case series.

PARTICIPANTS:

Premature infants with type 1 ROP (subdivided into stage 3+ ROP and aggressive posterior ROP [APROP]) in zone I or zone II posterior who received IVB monotherapy and were followed up for at least 65 weeks adjusted age (AA).

METHODS:

Retrospective review of infants who demonstrated recurrence of type 1 ROP after IVB monotherapy, including examination of RetCam fundus photographs and fluorescein angiograms.

MAIN OUTCOMES MEASURES:

Incidence, risk factors, risk period, and characteristics of recurrent ROP.

RESULTS:

Intravitreal bevacizumab monotherapy in 241 infants (471 eyes) was reviewed. Recurrence incidence was 8.3% (20/241) for infants and 7.2% (34/471) for eyes. Recurrence risk factors of greatest significance were appearance of neovascularization as APROP (P = 0.006), extended duration of hospitalization (P = 0.01), and lower birth weight (P = 0.024). Recurrence risk period was between approximately 45 and 55 weeks AA (90.0% [18/20] for infants and 94.1% [32/34] for eyes), with mean recurrence of 51.2 weeks AA (±4.6 weeks; range, 45.7-64.9 weeks) and mean interval of 16.2 weeks (±4.4 weeks) between treatments. Recurrence characteristics included plus disease (20/20 infants [100%]) and neovascularization, which appeared at the following sites: stage 3+ ROP with confluent neovascularization recurred both at the advancing edge and at the initial ridge and extraretinal fibrovascular proliferative complex (12/14 infants [85.7%]). However, APROP (6/6 infants [100%]) and stage 3+ ROP with nonconfluent neovascularization (2/14 infants [14.3%]) recurred only at the advancing edge. Also, the anterior extent of retinal vascularization was decreased (mean, 1.76 disc diameters [DD] vs. 4.48 DD), and the rate of retinal vascularization was delayed (mean, 0.11 DD/week vs. 0.23 DD/week) in those with versus without recurrence, respectively. After retreatment with IVB, retinal vascularization proceeded minimally and slowly.

CONCLUSIONS:

Premature children with severe ROP are being treated successfully with IVB monotherapy. However, recurrence is not uncommon, so vigilant follow-up is necessary to ensure timely re-treatment. Knowledge of recurrence incidence, risk factors, risk period, and characteristics allows for tailored clinical management.

PMID:
27241619
PMCID:
PMC4995132
DOI:
10.1016/j.ophtha.2016.04.028
[Indexed for MEDLINE]
Free PMC Article

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