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Marco H. Ji, Darius Moshfeghi, Ryan A Shields, Zachary Bodnar, Cassie A. Ludwig, Natalia F. Callaway, Theodore Leng, Steven Sanislo, Lorenzo Orazi, Giulia Amorelli, Domenico Lepore; Regression patterns of Retinopathy of Prematurity after intravitreal injection of Ranibizumab. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6538.
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© ARVO (1962-2015); The Authors (2016-present)
Safety regarding the use of agents that inhibit vascular endothelial growth factor (VEGF) in retinopathy of prematurity (ROP) is still controversial. We performed a retrospective, observational clinical study to evaluate the patterns of vascular regression following intravitreal ranibizumab injection (IVR) and correlated this with the amount of retinal nonperfusion as measured by fluorescein angiography (FA)
Retrospective cohortstudy conducted at a single institution. All infants treated with IVR for Type 1 ROP between July 2016 and November 2018 were included in this study. Both eyes of each baby received an intravitreal injection of 0.2 mg (0.02 mL) ranibizumab. Follow-up FAs were captured with the Retcam II/III (Natus Medical Inc., Pleasanton, CA) with a wide-field 130-defree lens using a bolus of 10% fluorescein solution intravenously at a dose of 0.1 ml/kg, followed by an isotonic saline flush. Digital composites of the angiograms were made using i2kRetina (DualAlign, Halfmoon, NY) and manually aligned using Pixelmator (Pixelmator Team, Vilnius, Lithuania). The distance between the vascular-avascular junction and ora serrata as well as the amount of avascular retina were measured in pixels and compared to optic disk diameter on the final montages with ImageJ (NIH, Bethesda, MD). Perfusion within two disk diameters from the ora serrata was considered as complete vascular maturity. Finally, the eyes were classified into separate regression patterns: complete vascular maturity, vascular arrest alone (VAA) and vascular arrest with tortuosity (VAT).
Among the total of 8 eyes of 5 caucasian babies available at follow-up, only 2 reached full vascular maturity, 6 eyes presented VAA and no one VAT.
Peripheral nonperfusion frequently persists following IVR. Therefore, infants treated with IVR should be closely monitored in order to minimize late ROP reactivation. Further studies are urged to better understand the long-term local effects of the drug on the developing retina of premature babies.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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