Mota Agata, Carneiro Angela, Breda Jorge, Rosas Vitor, Magalhães Augusto, Silva Renato, Falcão-Reis Fernando
Department of Ophthalmology, Hospital S. João, University of Porto, Porto, Portugal.
Case Rep Ophthalmol. 2012 Jan;3(1):136-41. doi: 10.1159/000338623. Epub 2012 Apr 30.
To report on 2 cases of aggressive posterior retinopathy of prematurity (ROP) treated with intravitreal ranibizumab (Lucentis(®)) and laser photocoagulation.
Two premature females, born at 25 and 26 weeks' gestation with a birth weight of 530 and 550 g, respectively, with aggressive posterior ROP received combined treatment with laser photocoagulation and intravitreal ranibizumab (0.3 mg [30 µl]) to each eye. Structural outcomes were evaluated by indirect ophthalmoscopy and documented by retinography.
An intravitreal injection was made at 34 weeks of postmenstrual age in the first case, followed by laser photocoagulation 1 week later. There was a partial regression of ROP with treatment. Five weeks later, neovascularization regrowth with bleeding in both eyes (intraretinal and subhyaloid) occurred and retreatment with combined therapy was performed. In the second case, single therapy with laser photocoagulation was made at 34 weeks of postmenstrual age. In spite of the confluent photocoagulation in the avascular area, progression to 4A ROP stage occurred 1 week later. Both eyes were retreated 1 week later with intravitreal ranibizumab and laser photocoagulation. Treatment resulted in ROP regression in both cases. There were no signs of systemic or ocular adverse side effects.
The cases presented show that combination therapy of indirect laser photocoagulation and intravitreal ranibizumab can be effective in the management of aggressive posterior ROP. Further investigation on anti-VEGF safety in premature infants is necessary. Additional studies are needed to define the role of anti-VEGF in ROP treatment.
报告2例采用玻璃体内注射雷珠单抗（Lucentis®）联合激光光凝治疗的侵袭性早产儿视网膜病变（ROP）。
2例早产女性，分别在孕25周和26周出生，出生体重分别为530 g和550 g，患有侵袭性后ROP，每只眼接受激光光凝联合玻璃体内注射雷珠单抗（0.3 mg [30 μl]）治疗。通过间接检眼镜评估结构转归，并通过视网膜造影记录。
第一例在孕龄34周时进行玻璃体内注射，1周后进行激光光凝。治疗后ROP部分消退。5周后，双眼出现新生血管再生并伴有出血（视网膜内和玻璃体下），遂再次进行联合治疗。第二例在孕龄34周时单独进行激光光凝治疗。尽管在无血管区进行了融合光凝，但1周后仍进展至ROP 4A期。1周后双眼再次接受玻璃体内注射雷珠单抗和激光光凝治疗。两例治疗后ROP均消退。未出现全身或眼部不良副作用迹象。
所呈现的病例表明，间接激光光凝联合玻璃体内注射雷珠单抗治疗侵袭性后ROP可能有效。有必要对早产儿抗血管内皮生长因子（VEGF）的安全性进行进一步研究。还需要更多研究来明确抗VEGF在ROP治疗中的作用。
