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Clinical Management of Recurrent Retinopathy of Prematurity after Intravitreal Bevacizumab Monotherapy
Helen A Mintz-Hittner1, Megan M Geloneck1, Alice Z Chuang2
1Ruiz 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.
Insights
Recurrence of retinopathy of prematurity (ROP) after intravitreal bevacizumab (IVB) monotherapy occurs in 8.3% of infants. Vigilant follow-up is crucial for timely re-treatment of ROP.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Medicine
Background:
- Retinopathy of prematurity (ROP) is a significant cause of vision impairment in premature infants.
- Intravitreal bevacizumab (IVB) has emerged as an effective treatment for severe ROP.
- Understanding recurrence patterns after IVB monotherapy is essential for optimizing patient management.
Purpose of the Study:
- To determine the incidence, risk factors, risk period, and characteristics of recurrent retinopathy of prematurity (ROP) following intravitreal bevacizumab (IVB) monotherapy.
- To identify predictors of ROP recurrence after IVB treatment.
Main Methods:
- Retrospective case series analysis of premature infants with type 1 ROP treated with IVB monotherapy.
- Follow-up to at least 65 weeks adjusted age (AA) with examination of fundus photographs and fluorescein angiograms.
- Statistical analysis to identify significant risk factors and recurrence patterns.
Main Results:
- Recurrence incidence was 8.3% for infants and 7.2% for eyes.
- Key risk factors for recurrence included aggressive posterior ROP (APROP), prolonged hospitalization, and lower birth weight.
- Recurrence typically occurred between 45-55 weeks AA, characterized by plus disease and neovascularization at specific retinal sites.
Conclusions:
- IVB monotherapy is effective for severe ROP, but recurrence is a notable concern.
- Vigilant monitoring and timely re-treatment are necessary to manage ROP recurrence.
- Knowledge of recurrence patterns aids in personalized clinical management strategies for ROP.
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.
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