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Conserved regression patterns of retinopathy of prematurity after intravitreal ranibizumab: A class effect
Marco H Ji1, Darius M Moshfeghi1, Ryan A Shields2
1Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA.
Insights
Intravitreal ranibizumab (IVR) for retinopathy of prematurity (ROP) shows similar regression patterns to bevacizumab, indicating a class effect. Fluorescein angiography (FA) can help manage ROP treatment following IVR.
Area of Science:
- Ophthalmology
- Neonatology
- Vascular Biology
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Intravitreal anti-VEGF agents are used to treat ROP.
- Bevacizumab has demonstrated a class effect in ROP regression patterns.
Purpose of the Study:
- To evaluate if fluorescein angiographic (FA) findings after intravitreal ranibizumab (IVR) for ROP align with the known class effect of bevacizumab.
- To assess the vascular maturity and regression patterns post-IVR treatment in infants with ROP.
Main Methods:
- Retrospective case series of 13 infants (24 eyes) treated with 0.2 mg IVR for Type 1 ROP.
- Wide-angle FA imaging at multiple postmenstrual ages (40-72 weeks).
- Classification of eyes based on avascular areas and vessel tortuosity: complete vascular maturity, VAA, VAT, and reactivation.
Main Results:
- None of the eyes achieved complete vascular maturity by 60 weeks PMA.
- Significant proportions of eyes showed VAA (29%), VAT (33%), and reactivation (37.5%).
- Reactivated eyes exhibited the largest peripheral ischemia areas (p=0.02).
Conclusions:
- IVR demonstrates regression patterns consistent with a class effect, similar to bevacizumab in ROP.
- FA follow-up is valuable for optimizing ROP management post-IVR.
- Findings suggest a shared therapeutic mechanism for anti-VEGF agents in ROP treatment.
Purpose:
To determine if fluorescein angiographic (FA) findings after intravitreal ranibizumab (IVR) for retinopathy of prematurity (ROP) conform to a class effect previously described with bevacizumab.
Methods:
Single-center retrospective case series of all infants treated with 0.2 mg (0.02 mL) IVR for Type 1 ROP from July 2016 to November 2018. FA were obtained at 40, 52, 62, and 72 weeks of postmenstrual age (PMA) using wide-angle photography. FA images were analyzed and the peripheral avascular areas measured with ImageJ using a reference disc diameter (DD). Based on the extent of the avascular area and tortuosity of the retinal vessels all eyes were classified into four categories: complete vascular maturity (vascularization within 2 DD of the ora serrata), VAA (avascular area >2 DD of the ora serrata), VAT (avascular area >2 DD of the ora serrata and posterior tortuosity), and reactivation (recurrence of stage disease).
Results:
About 13 infants were enrolled and 24 eyes were available in this study. None of the eyes reached complete vascular maturity at an average PMA of 60 weeks, 7 (29%) eyes presented with VAA, 8 (33%) with VAT, and 9 (37.5%) reactivated. The reactivated eyes presented with the largest area of peripheral ischemia, followed by the VAT and then the VAA groups (p = 0.02).
Conclusion:
IVR conforms to the previously described regression patterns following intravitreal bevacizumab for ROP indicative of a class effect. Follow-up using FA might help to optimize the management of these infants after injection of the drug.
