Smouldering retinopathy of prematurity: a case treated by multiple antivascular endothelial growth factor therapy

Area of Science:

• Ophthalmology
• Neonatology
• Pediatric Medicine

Background:

• Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
• Early detection and treatment are crucial to prevent severe visual outcomes.
• Anti-vascular endothelial growth factor (anti-VEGF) agents are commonly used for ROP management.

Observation:

• A 13-month-old female infant, born at 24 weeks gestational age, presented with advanced ROP (Stage 4A in the right eye, Stage 3 in the left eye) with plus disease.
• Initial treatment with intravitreal bevacizumab was administered at 32 weeks gestational age.
• Recurrence of ROP was observed, requiring further injections of bevacizumab and ranibizumab at 39 and 57 weeks postmenstrual age, respectively.

Findings:

• Despite multiple anti-VEGF injections, the infant experienced late recurrence with progression to Stage 4A in the right eye and pre-retinal hemorrhages in the left eye.
• Laser treatment to the peripheral avascular retina was performed at 67 weeks postmenstrual age.
• This case illustrates a late recurrence of ROP managed initially with anti-VEGF monotherapy.

Implications:

• The findings suggest that anti-VEGF agents alone may not be sufficient for all ROP cases, especially those with atypical presentations or late recurrences.
• Clinicians should exercise caution when using anti-VEGF agents as monotherapy in ROP management.
• Further research is needed to understand the long-term efficacy and optimal treatment strategies for complex ROP cases.