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Primary intravitreal ranibizumab for high-risk retinopathy of prematurity
Insights
Low-dose intravitreal ranibizumab rapidly resolves high-risk retinopathy of prematurity (ROP). However, recurrent ROP may occur, necessitating careful monitoring and potential laser treatment to preserve peripheral retina.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Pharmacology
Background:
- High-risk retinopathy of prematurity (ROP) poses a significant threat to infant vision.
- Current treatments for posterior ROP can have long-term consequences.
Purpose of the Study:
- To assess the efficacy and safety of low-dose intravitreal ranibizumab as an initial treatment for high-risk ROP.
- To evaluate the resolution of ROP and plus disease following ranibizumab injection.
Main Methods:
- A case series involving premature infants with high-risk pre-threshold or threshold posterior ROP.
- Infants received a primary therapy of 0.2 mg ranibizumab via intravitreal injection.
- Evaluations included pre- and post-injection examinations, imaging, and assessment of ROP resolution and stability.
Main Results:
- Ranibizumab injection led to rapid resolution of plus disease within 48 hours.
- Complete regression of stage 3 ROP was observed within 1 week.
- Recurrent ROP in anterior zones occurred 8-11 weeks post-injection, successfully treated with peripheral laser.
- Long-term follow-up (8-18 months) showed stable retinas without recurrence or detachment.
Conclusions:
- Intravitreal ranibizumab effectively induces rapid regression of high-risk posterior ROP.
- Vigilant monitoring is crucial due to the potential for ROP recurrence after ranibizumab.
- Peripheral laser treatment for recurrences can preserve the posterior retina from photocoagulation.
Background And Objective:
To evaluate initial treatment of high-risk retinopathy of prematurity (ROP) with low-dose intravitreal ranibizumab.
Patients And Methods:
Case series of premature infants with high-risk pre-threshold or threshold posterior ROP receiving primary therapy with 0.2 mg ranibizumab. Pre-treatment and post-injection examination, RetCam (Clarity Medical Systems, Pleasanton, CA) images, fluorescein angiography, resolution of ROP and plus disease, and stability of examinations were assessed.
Results:
Eight eyes of four infants received primary ranibizumab treatment. Plus disease resolved within 48 hours of unilateral injection, and there was no change in ROP appearance in the contralateral eye. Complete resolution of stage 3 ROP occurred 1 week after injection. Recurrent progressive stage 2 or 3 ROP in mid to anterior zone 2 was noted 8 to 11 weeks after ranibizumab in all eyes. Treatment of recurrent ROP with peripheral laser led to complete ROP regression. Comparison of images before ranibizumab injection to images after ROP recurred demonstrated anterior retinal growth. Retina examinations remained stable without ROP recurrence or detachment at follow-up 8 to 18 months after ranibizumab injection.
Conclusion:
Intravitreal ranibizumab induces rapid, complete regression of high-risk posterior ROP with continued retina growth peripherally. The potential for recurrent ROP after a single 0.2 mg ranibizumab injection for posterior ROP requires vigilant monitoring. Subsequent peripheral laser for ROP recurrences may spare the posterior retina from photocoagulation effects.
