Hillier Roxane J, Connor Alan J, Shafiq Ayad E
Department of Ophthalmology, Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
Br J Ophthalmol. 2018 Feb;102(2):260-264. doi: 10.1136/bjophthalmol-2017-310408. Epub 2017 Jun 27.
Intravitreal bevacizumab (IVB) has emerged as an effective treatment modality for the management of retinopathy of prematurity (ROP) where the disease is severe and posterior. Despite evidence of systemic vascular endothelial growth factor suppression and concerns about how this might affect the developing neonate, the optimal dose is unknown to date. We report our experience of using ultra-low-dose (0.16 mg) IVB, one-quarter of the 'standard' dose that has widely been reported in the treatment of ROP.
A retrospective observational case series of consecutive infants who underwent ultra-low-dose IVB injection for the management of ROP at a regional neonatal intensive care unit in the North East of England, between November 2013 and August 2016.
29 eyes of 15 infants underwent IVB injection. We defined 'treatment success' as complete regression of retinopathy and vascularisation into (or laser ablation of) zone 3. Primary success (in response to IVB 0.16 mg alone) was observed in 23/29 eyes (79.3%). Secondary success (where additional treatment was required) was observed in 27/29 eyes (93.1%). One infant died of respiratory disease during follow-up. Retreatment occurred in 6/29 eyes (20.6%). Retreatments occurred at a mean of 9.8 weeks after initial IVB (range 6-15) and at a mean of 44 weeks postmenstrual age (range 40-50).
0.16 mg IVB is effective in the treatment of severe and posterior ROP, with no adverse ocular outcomes occurring in our series.
玻璃体内注射贝伐单抗（IVB）已成为治疗重度后部早产儿视网膜病变（ROP）的一种有效治疗方式。尽管有证据表明其可抑制全身血管内皮生长因子，且人们担心这可能会对发育中的新生儿产生影响，但迄今为止最佳剂量仍未知。我们报告了使用超低剂量（0.16毫克）IVB的经验，该剂量仅为治疗ROP时广泛报道的“标准”剂量的四分之一。
这是一项回顾性观察性病例系列研究，研究对象为2013年11月至2016年8月期间在英格兰东北部一家地区新生儿重症监护病房接受超低剂量IVB注射治疗ROP的连续婴儿。
15名婴儿的29只眼睛接受了IVB注射。我们将“治疗成功”定义为视网膜病变完全消退且血管化进入3区（或对3区进行激光消融）。23/29只眼睛（79.3%）观察到初次治疗成功（仅对0.16毫克IVB有反应）。27/29只眼睛（93.1%）观察到二次治疗成功（需要额外治疗）。一名婴儿在随访期间死于呼吸系统疾病。6/29只眼睛（20.6%）进行了再次治疗。再次治疗平均发生在初次IVB注射后9.8周（范围6 - 15周），平均在孕龄44周（范围40 - 50周）。
0.16毫克IVB治疗重度后部ROP有效，我们的系列研究中未出现不良眼部结局。
