Maitra Puja, Prema Subramaniam, Narendran Venkatapathy, Shah Parag K
Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore 641014, Tamil Nadu, India.
World J Clin Pediatr. 2023 Sep 9;12(4):220-229. doi: 10.5409/wjcp.v12.i4.220.
Intravitreal anti-vascular endothelial growth factor (IVA) injection is known to cause contraction of fibrovascular proliferation (FVP), when present in severe retinopathy of prematurity (ROP).
To assess the structural outcomes of IVA injection in the treatment of severe posterior ROP with significant FVP.
It was a retrospective study in which 36 eyes of 18 preterm babies who developed > 4 clock hours of FVP in zone I or posterior zone II, were treated with either intravitreal 0.625 mg bevacizumab or intravitreal 0.2 mg of ranibizumab. Favorable structural outcome included resolution of plus disease and FVP without the development of tractional retinal detachment. Secondary outcome measure included either full retinal maturation at follow-up or development of recurrent disease requiring additional treatment. Adverse outcomes included progression to retinal detachment.
The mean gestational age of the 18 preterm babies was 30 wk (range 27-36), and mean birth weight was 1319 g (range 650-1980 g). Mean post-menstrual age (PMA) at the time of primary treatment was 35.5 wk (range 31-41 wk). All eyes showed regression of plus disease and FVP. 5 eyes of 3 babies showed reactivation of disease and were treated with repeat IVA ( = 2 eyes) or peripheral laser photocoagulation ( = 3 eyes) respectively. 16 out of 36 (44%) reached retinal vascular maturation at final follow up at 5 years.
There was good resolution of severe posterior ROP with FVP with IVA, with retinal maturity of 44% at 5 year follow-up and a reactivation rate of 13.8%. When the IVA injection is given prior to 37 wk PMA, while disease is in phase 2, it is less likely to cause contracture of pre-existing FVP.
已知玻璃体内注射抗血管内皮生长因子（IVA）可使存在于重度早产儿视网膜病变（ROP）中的纤维血管增殖（FVP）发生收缩。
评估IVA注射治疗伴有显著FVP的重度后部ROP的结构转归。
这是一项回顾性研究，18例早产儿的36只眼出现I区或后部II区超过4个钟点范围的FVP，接受玻璃体内注射0.625mg贝伐单抗或0.2mg雷珠单抗治疗。良好的结构转归包括附加病变和FVP消退且未发生牵拉性视网膜脱离。次要转归指标包括随访时视网膜完全成熟或出现需要额外治疗的复发性疾病。不良转归包括进展为视网膜脱离。
18例早产儿的平均胎龄为30周（范围27 - 36周），平均出生体重为1319g（范围650 - 1980g）。初次治疗时的平均月经后年龄（PMA）为35.5周（范围31 - 41周）。所有眼的附加病变和FVP均消退。3例婴儿的5只眼出现疾病复发，分别接受重复IVA治疗（2只眼）或周边激光光凝治疗（3只眼）。36只眼中有16只（44%）在5年最终随访时达到视网膜血管成熟。
IVA治疗伴有FVP的重度后部ROP效果良好，5年随访时视网膜成熟率为44%，复发率为13.8%。当在PMA 37周之前、疾病处于2期时给予IVA注射，发生原有FVP挛缩的可能性较小。
