Abstract
Purpose :
Intravitreal ranibizumab injection is the preferred first-line treatment for retinopathy of prematurity (ROP), but factors affecting retreatment are still ambiguous. A retrospective study was conducted to investigate the predictive factors for retreatment after the intravitreal ranibizumab injection as a first-line treatment in type 1 ROP.
Methods :
The consecutive medical records of infants diagnosed with type 1 ROP from 2013 to 2021 and injected intravitreal ranibizumab 0.2 mg as the first treatment were reviewed. Only eyes with more severe ROP were included. Retreatment was performed with laser photocoagulation when ROP was reactivated. Various factors around the first injection affecting retreatment were assessed.
Results :
Intravitreal ranibizumab was injected into 44 eyes of 44 infants. The mean gestational age (GA) and body weight were 27+6 weeks and 1,047 g, respectively. Retreatment was required in 21 eyes (47.7%) at an average of 8.9 weeks after the first injection at 37+1 weeks of mean GA. The retreatment group was presented with an earlier GA (26+5 vs. 28+5 weeks, p = 0.036), lower 1-minute (3.4 vs. 4.7, p = 0.014) and 5-minute (6.0 vs. 6.8, p = 0.036) Apgar scores, and more quadrants with plus sign (2.8 vs. 2.3, p = 0.044) before the injection. After the injection, the retreatment group showed a longer period of oxygen requirement (10.2 vs. 3.6 weeks, p = 0.001), late loss of plus sign (6.9 vs. 4.1 days, p = 0.014), and a longer complete involution time of ROP (18.0 vs. 12.5 weeks, p = 0.003). In multivariate logistic regression analysis (Table 1.), the risk for retreatment was increased with a lower 1-minute Apgar score (p = 0.010, OR = 2.04) and later disappearance of plus sign (p = 0.013, OR = 1.44) after the first injection.
Conclusions :
About half of the type 1 ROP may need retreatment two months after the first ranibizumab injection. Delayed loss of plus sign can increase the possibility of retreatment; careful fundus examination is recommended after the first injection.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.