Impact of Intravitreal Ranibizumab on Retinopathy of Prematurity: A Retrospective Analysis
Fumihiko Nitta1, Hiroshi Kunikata1, Shimpei Watanabe2
1Ophthalmology, Tohoku University, Sendai, JPN.
Insights
Intravitreal ranibizumab (IVR) has transformed retinopathy of prematurity (ROP) treatment, reducing laser use and eliminating retinal detachment (RD) in a Japanese cohort. This targeted therapy shows promise for better visual outcomes in premature infants.
Area of Science:
- Ophthalmology
- Neonatology
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a significant cause of vision impairment in premature infants.
- Traditional treatments like retinal photocoagulation (RPC) can have limitations.
- The introduction of intravitreal ranibizumab (IVR) offered a new therapeutic option.
Purpose of the Study:
- To evaluate the real-world impact of intravitreal ranibizumab (IVR) on ROP treatment patterns.
- To assess changes in severe complications, specifically retinal detachment (RD), following IVR introduction.
- To compare treatment outcomes before and after IVR availability in a Japanese tertiary hospital setting.
Main Methods:
- Retrospective analysis of 785 infants born at ≤1800 g or ≤34 weeks gestation (January 2016 - December 2022).
- Comparison of treatment patterns (RPC vs. IVR) and RD incidence in pre- and post-IVR eras.
- Analysis included infants meeting Early Treatment for Retinopathy of Prematurity (ETROP) criteria.
Main Results:
- The proportion of infants treated with RPC significantly decreased post-IVR introduction (9.7% to 5.4%, p=0.03).
- The incidence of retinal detachment (RD) dropped from 2.1% to 0% after IVR introduction (p=0.01).
- No significant change in the distribution of extremely low birth weight (ELBW) infants was observed between eras.
Conclusions:
- Intravitreal ranibizumab (IVR) has shifted ROP treatment paradigms, reducing reliance on RPC.
- IVR introduction was associated with the complete elimination of retinal detachment (RD) in this cohort.
- IVR presents a less destructive alternative, potentially improving long-term visual outcomes in ROP patients.
Abstract:
Purpose The purpose of this study was to evaluate the impact of intravitreal ranibizumab (IVR) introduction on treatment patterns for retinopathy of prematurity (ROP) and the incidence of severe complications, including retinal detachment (RD), in a real-world setting. Methods We retrospectively analyzed 785 infants born at ≤1800 g or ≤34 weeks of gestation between January 2016 and December 2022 at two tertiary hospitals in Japan. IVR (0.2 mg/0.02 mL) was introduced in August 2020 at Tohoku University Hospital and in December 2019 at Miyagi Children's Hospital. Infants meeting Early Treatment for Retinopathy of Prematurity (ETROP) criteria received either retinal photocoagulation (RPC), IVR, or both, depending on the treatment era. Severe cases with RD (stage 4A or higher) were managed with scleral buckling or vitreous surgery as needed. Results Of the 472 infants treated prior to IVR introduction, 41.3% were extremely low birth weight (ELBW), comparable to 41.5% among the 291 infants treated after IVR introduction. The proportion undergoing RPC significantly decreased from 9.7% to 5.4% following IVR availability (p=0.03). Notably, the incidence of RD dropped from 2.1% to 0% after IVR introduction (p=0.01), despite no significant change in ELBW distribution. Conclusion The introduction of IVR has markedly shifted ROP treatment paradigms, reducing reliance on RPC and completely eliminating RD in our cohort. IVR offers a targeted, less destructive therapeutic alternative, potentially preserving retinal architecture and improving long-term visual outcomes. While these findings are encouraging, prospective studies are needed to further assess the safety and efficacy of IVR in this vulnerable population.
