Abstract
Purpose :
The objective of this case series is to discuss the role of repeat intravitreal ranibizumab (IVR) in treating posterior retinopathy of prematurity (ROP). To our knowledge, there are only 2 other reported cases using repeat intravitreal injections (IVI) for ROP.
Methods :
We report 2 cases of premature infants born at gestational age (GA) 23-24 weeks (w) with birthweight (BW) of 540-601g at university neonatal intensive care units who were treated with IVR (0.25 mg/0.025 mL) for recurrent posterior ROP followed by delayed laser for anterior recurrence.
Results :
First case is a female (GA = 23-2/7w, BW = 540 g) with bronchopulmonary dysplasia (BPD) and sepsis. Exam at post-menstrual age (PMA) 31-3/7w showed zone 1, stage 3, no plus in both eyes (OU) and was treated with IVR OU. Repeat IVR was given OU at 38-0/7w for recurrence (zone 1-2, stage 2, pre-plus OU). Laser was performed OU at 47-4/7w for zone 2, stage 3 with pre-plus OU. The following week, patient had worsening plus OU and was treated with additional laser. ROP regressed OU at follow up.
Second case is a female (GA = 23 4/7w, BW = 601 g) with BPD, sepsis, and hypotension. IVR OU were given at 34-1/7w for vitreous hemorrhages (VH) OU and zone 1, stage 3 with plus OU. OS was reinjected at 39-1/7w for worsening VH and zone 1, stage 2, pre-plus and OD at 40-1/7w for zone 1, stage 2, pre-plus. At 51-1/7w, ROP reactivated (anterior zone 2, stage 3 without plus) and laser was performed. ROP regressed OU at follow up.
Conclusions :
Repeat IVI was selected over laser because of posterior recurrence. A second IVI was performed to allow further peripheral vascularization of the retina, with the added benefit of avoiding general anesthesia in critically ill infants until they are older. IVR was chosen because it has a shorter systemic half-life compared to bevacizumab, theoretically causing less side effects. However, ranibizumab has been associated with earlier ROP recurrence compared to bevacizumab.
In conclusion, this case series demonstrates the use of repeat IVR in posterior recurrence of ROP. As advances in neonatal care continue to evolve and infant viability extends to younger GA, the use of repeat IVI for ROP may be increasingly necessary. Future studies could seek to determine the safest and most effective agent, dose, and interval for repeat IVI.
This is a 2021 ARVO Annual Meeting abstract.