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SHORT-TERM REACTIVATION OF RETINOPATHY OF PREMATURITY AFTER PRIMARY RANIBIZUMAB TREATMENT
Jason Strawbridge1, John Y Cheng1, Bradley S Gundlach1
1Division of Retina and Vitreous Diseases, Stein and Doheny Eye Institutes, University of California Los Angeles, Los Angeles, CA.
Insights
Short-term reactivation of retinopathy of prematurity (ROP) after intravitreal ranibizumab (IVR) therapy can occur, especially in zone I disease. Repeat IVR injections are effective and safe for ROP, but further reactivation is possible.
Area of Science:
- Ophthalmology
- Neonatal Care
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a leading cause of vision impairment in premature infants.
- Intravitreal ranibizumab (IVR) has emerged as a treatment option for aggressive ROP.
- Understanding factors influencing ROP reactivation after IVR is crucial for optimizing treatment strategies.
Purpose of the Study:
- To identify risk factors associated with short-term reactivation of ROP following initial intravitreal ranibizumab (IVR) therapy.
- To evaluate the safety and efficacy of repeat IVR injections for managing ROP reactivation.
Main Methods:
- Retrospective chart review of patients treated with IVR for ROP between 2013 and 2023.
- Analysis of ROP reactivation rates, timing, and associated risk factors (zone, postmenstrual age, gestational age).
- Assessment of adverse events and outcomes following repeat IVR injections.
Main Results:
- Short-term ROP reactivation occurred in 30.2% of patients (26.8% of eyes) an average of 7.2 weeks post-treatment.
- Risk factors for reactivation included zone I disease, lower postmenstrual age at first injection, and lower gestational age at birth.
- Repeat IVR injections were administered to 13 patients; 11.6% required subsequent laser treatment for a second reactivation. No major adverse events like vascular occlusion or endophthalmitis were observed.
Conclusions:
- Repeat intravitreal ranibizumab injections may be necessary for aggressive retinopathy of prematurity.
- Repeat IVR treatment for ROP demonstrates effectiveness with a low incidence of ophthalmic adverse events.
- While generally safe, the potential for additional ROP reactivation after repeat IVR necessitates continued monitoring.
Purpose:
Investigate risk factors for short-term reactivation of retinopathy of prematurity (ROP) after intravitreal ranibizumab (IVR) therapy and determine safety and efficacy of repeat injections.
Methods:
Retrospective chart review study of patients screened for ROP as inpatients between 2013 and 2023 who received IVR within the UCLA health care system. Primary outcomes were rates and timing of short-term ROP reactivation, defined as repeat worsening of ROP to stage 2 or 3 before 52 weeks postmenstrual age, as well as risk factors for reactivation. Other outcomes included adverse events and rates of reactivation after a second intravitreal injection.
Results:
Eighty-two eyes of 43 patients received primary IVR 0.25 mg/0.025 cc for type 1 ROP. Thirteen patients (22 eyes) (30.2% of patients, 26.8% of eyes) developed short-term reactivation an average of 7.2 weeks ± 1.7 weeks after treatment. Increased reactivation risk was associated with zone I disease (odds ratio 6.23, 95% CI, 1.35-28.7, P = 0.019), lower postmenstrual age at first injection (odds ratio 1.64, 95% CI, 1.19-2.26; P = 0.003), and lower gestational age at birth (odds ratio 1.80, 95% CI, 1.04-3.13, P = 0.037). Of the 13 patients that received repeat injections, five required laser treatment for a second reactivation (11.6% of patients receiving IVR). No eyes developed retinal vascular occlusion, endophthalmitis, or cataract.
Conclusion:
Repeat injections may be required after primary IVR for aggressive ROP. Repeat IVR treatment for ROP is effective and poses few ophthalmic adverse events, although additional reactivation remains a risk.
