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C. Abdala, C. Vizcaino, A. Abdala, M. R. George, P. J. Rychwalski; Rescue Therapy as a Primary Treatment in Severe Types of Retinopathy of Prematurity. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5727.
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To report the authors’ experience using Rescue Therapy (Bevacizumab and Retinal Panphotocoagulation) as a primary treatment in preterm babies with severe ROP, stages III or IV, and to describe the anatomical results.
7 patients (14 eyes) with severe types of ROP (defined as either ROP Stage III, Zone I or II thereshold with severe plus disease, or as ROP Stage IV A or B with severe plus diasease) received both panretinal photocoagulation and a single bevacizumab 0.65 mg (0.05 cc) intravitreal injection at the same time. All treatments were performed in the operating room under sterile conditions by a single vitreoretinal surgeon (CA). Patients were then followed until both regression of ROP and clearance of any coexisting vitreous hemorrhage was observed. Baseline characteristics (birth weight, gestational age, age at time of treatment) were recorded and compared.
At four weeks following the initial procedure, eight eyes demonstrated regression of ROP, resolution of vitreous hemorrhage and an attached retina. Six eyes required an additional bevacizumab injection (0.65 mg) and photocoagulation on the ridge for residual disease. Following the second treatment, all eyes showed regression of ROP at seven weeks. Two eyes exhibited tractional retinal detachments requiring repair, and four eyes had persistence of macular and disc dragging OU.
Involution of severe ROP in eyes treated with combination bevacizumab and laser photocoagulation occurred within four weeks in over half of treated eyes. This combination therapy as a primary treatment in severe types of ROP is useful in halting ROP progression, and delivers promising structural results. Long term follow-up is needed to monitor side effects and functional results of this intervention.
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