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Christine Sonnie, Jonathan E Sears; FEVR-like Phenotype of Zone 1 Type 1 Infants Treated with anti-VEGF Therapy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3769.
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© ARVO (1962-2015); The Authors (2016-present)
Anti-VEGF therapy for treatment of Zone 1 Type 1 eyes has been definitively demonstrated to reduce unfavorable outcome in comparison to laser but is also reported to inhibit complete vascularization of the retina (1). We retrospectively analyzed retinal outcomes after 0.5 mgs intravitreal bevacizumab to treat Zone 1 Type 1 eyes.
After informed consent was obtained, infants with Zone 1 Type 1 disease were treated with 0.5 mgs intravityreal bevacizumab each eye. Patient demographics and clinical course of all infants treated with 0.5 mgs bevacizumab between September 2013 thru August 2017 were retrospectively identified. Fluorescein angiography was performed if possible and vascular abnormalities identified.
27 infants (54 eyes) were treated with a mean follow-up of 6 months. Mean gestational age at birth (GA) was 24.2 weeks; mean birth weight (BW) was 641 grams. 25 infants regressed stage 3 completely; 46/54 eyes (85%) demonstrated vascular arrest whereas 8 eyes became fully vascularized. Mean corrected gestational age (CGA) at anti-VEGF treatment was 36.8 weeks compared to 35 weeks (range 33-39 weeks) in infants that showed vascular arrest (p=0.003). Three eyes of 2 children progressed to 4a detachments even after laser, one of these two children died of sepsis at CGA 37 weeks. All eyes with vascular arrest were treated with laser as a precaution against late retinal detachment. The mean age at laser was 42.9 weeks (range 34-63 weeks). In eyes that had vascular arrest, FA demonstrated scalloped borders with cats paw-like termination of leading vascular edge, leakage, and abnormnal anastomotic vasculature with long redirection of vessels along a meridian parallel to the ora serrata. Lower CGA at birth, lower birth weight, and lower CGA at time of anti-VEGF treatment were related to a decreased chance for full vascularization.
Bevacizumab can prevent complete vascularization and creates a FEVR like phenotype (vascular arrest). The age at treatment may correlate to vascular arrest. The FEVR-like pattern of vascular arrest also suggests that the timing of VEGF downregulation underlies the development of congenital retinovascular disease other than ROP.1-Toy BC, Schachar IH, Tan GS, Moshfeghi DM. Chronic Vascular Arrest as a Predictor of Bevacizumab Treatment Failure in Retinopathy of Prematurity. Ophthalmology. 2016 Oct;123(10):2166-75.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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