Vitreoretinal interfase changes in the fibrovascular demarcation line after intravitreal bevacizumab for type 1 retinopathy of prematurity

Abstract

 

Purpose

 

To report the changes in the vitreoretinal interfase of the fibrovascular demarcation line after intravitreal bevacizumab for stage 3, zone 1 or 2 with plus disease retinopathy of prematurity (ROP)

 

Methods

 

Non comparative, prospective, case series. We included ten eyes of five premature patients of 2 different centers one in Mexico and one in India who were treated for type 1 ROP with 0.03cc/(0.75 mg) intravitreal bevacizumab as monotherapy. Demographic data: gender, birth weight, gestational age at birth, age at treatment and severity of ROP were recorded. Weekly clinical photographs and fluorangiography (performed every 2 weeks) were obtained using the RETCAM system (Clarity medical systems) Additional information was obtained by spectral domain optical coherence tomography iVue (Optovue corporation)

 

Results

 

After the injection of bevacizumab in all 10 eyes pathological neovascularization regressed, the fibrovascular ridge persisted fibrotic for 3 to 5 weeks after the injection in the demarcation line, some retina traction without detachment was observed in the OCT scan in the ridge area. In the third week we could assessed by angiography that retinal normal vasculature was developing under the fibrotic ridge towards the periphery. Between the sixth and eight weeks after injection, the fibrovascular ridge completely detached in all ten eyes. Large vitreous condensations are visible in all the eyes

 

Conclusions

 

Vitreous adhesion in pediatric pathologies is poorly understood, there are some reports of tractional retinal detachment and retinal crunch after the use of antiangiogenic therapy for ROP treatment. As more babies are treated worldwide, we will be able to fill the gaps on the safety profile of these drugs that were not address in clinical trials or small series. As new clinical features of ROP after anti VEGF treatment emerge, such as the ones presented, pediatric retina specialists will be face with questions regarding appropiate follow up and possible complications such as retinal hole formation and retinal detachment on these patients

 

Keywords: 706 retinopathy of prematurity • 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)