Risk of recurrence of retinopathy of prematurity after initial intravitreal ranibizumab therapy
Joyce J T Chan1, Carol P S Lam1, Madeline K M Kwok1
1Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, 147K, Argyle Street, Kowloon City, Kowloon, Hong Kong SAR.
Insights
Intravitreal ranibizumab monotherapy for retinopathy of prematurity (ROP) showed high rates of persistent disease and recurrence. Adjunctive laser therapy is often needed, suggesting careful monitoring for ROP treatment.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Intravitreal anti-VEGF agents are increasingly used for ROP treatment.
- Ranibizumab is an anti-VEGF medication used off-label for ROP.
Purpose of the Study:
- To evaluate the efficacy and safety of intravitreal ranibizumab in treating retinopathy of prematurity.
- To compare ranibizumab monotherapy versus combination therapy with laser.
- To assess recurrence rates and the need for subsequent treatments.
Main Methods:
- Retrospective review of 138 infants with ROP over 18 months.
- Intravitreal ranibizumab administered in selected cases (aggressive posterior ROP, poor mydriasis).
- Analysis of treatment outcomes including persistence, recurrence, and need for laser therapy.
Main Results:
- 3 of 8 eyes (37.5%) treated with ranibizumab monotherapy had persistent ROP requiring laser.
- 3 of 5 eyes (60%) with initial regression experienced recurrence at a mean of 7.6 weeks.
- 2 eyes treated with laser followed by ranibizumab showed regression without recurrence.
Conclusions:
- Intravitreal ranibizumab monotherapy for ROP is associated with significant rates of persistent disease and recurrence.
- Recurrence rates appear higher and earlier than with intravitreal bevacizumab.
- Close monitoring and potential adjunctive laser therapy are crucial for ROP eyes treated with ranibizumab.
Abstract:
We report our experience with the use of intravitreal ranibizumab for the treatment of retinopathy of prematurity (ROP). A retrospective review was performed on 138 consecutive infants screened at a single centre over 18 months. Intravitreal ranibizumab was offered in selected cases requiring treatment, such as aggressive posterior ROP or poor mydriasis. 2 eyes of 1 infant received intravitreal ranibizumab alone and 8 eyes of 5 infants received combined intravitreal ranibizumab and laser therapy. 3 out of 8 eyes treated initially with intravitreal ranibizumab monotherapy had persistent disease requiring laser therapy, and 3 out of 5 eyes with initial regression suffered disease recurrence at a mean of 7.6 weeks post-injection. 2 eyes treated first with laser followed by intravitreal ranibizumab had disease regression without recurrence. Our cohort demonstrate a significant rate of persistent disease and recurrence in ROP eyes treated initially with intravitreal ranibizumab monotherapy, which is greater and earlier than that reported for intravitreal bevacizumab in the BEAT-ROP study. Intravitreal ranibizumab may be useful as an initial treatment in selected cases of ROP when laser therapy as first line is suboptimal. However, close monitoring is important and adjunctive laser therapy may subsequently be needed in a majority of cases.
