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P. J. Rychwalski, M. Montoya Baena, A. Abdala, C. Abdala Caballero; Rescue Therapy With Bevacizumab in Infants With Retinopathy of Prematurity (ROP) Unresponsive to Laser Photocoagulation. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5049.
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To describe the successful treatment of severe, progressive ROP - despite laser photocoagulation - with intravitreal Bevacizumab (Avastin®).Bevacizumab ,a VEGF inhibitor, has been used as a rescue therapy in preterm babies with retinopathy of prematurity (ROP). The therapy is considered after failure of resolution of threshold or Type I ROP after laser photocoagulation. We analyzed the results of intravitreal injection of Bevacizumab in 10 eyes of 5 preterm infants with gestational age (GA) of 32 weeks or less and a birth weight (BW) of 1500 g or less.
7 of 10 eyes had stage 3 ROP. 5 of the 10 eyes had ROP in zone II and 2 in zone I. 7 of 10 eyes were initially treated with confluent retinal photocoagulation in the avascular periphery as primary treatment. 2 eyes had ROP stage 3, zone II with plus disease and had received cryotherapy as a primary treatment at another center. Two weeks after this procedure was performed, the infant was referred to our center because the disease had advanced to ROP stage 4b, zone II. Laser and intravitreal Bebacizumab were then used as rescue therapies. 1 eye presented with stage 4a ROP and was treated directly with rescue therapy.Two weeks after primary treatment, rescue therapy was employed because the disease was active and evolving despite complete laser or cryo treatment. The rescue therapy included laser photocoagulation of the retina adjacent to the temporal ridge combined with a single intravitreous injection of Bevacizumab (1.25 mgs./0.05cc).
In all 10 cases, the rescue therapy halted disease progression, with regression of new vessels and plus disease. In all 3 cases of stage 4 ROP, the retina reattached spontaneously mantaining the dragging disc diagnosed before treatment was employed.
In 10 cases were Bevacizumab was used as a rescue therapy combined with laser, the disease stopped its evolution and plus disease disappeared. The retina reattached spontaneously in eyes that had had a partial detachment. Bevacizumab (Avastin®) can be considered for rescue therapy in cases of ROP that continue to progress despite aggressive initial photo-destructive therapy. More studies need to be conducted in order to minimize potential side effects, and determine proper dosing and timing of injection.
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