The vascularization process after intravitreal ranibizumab injections for aggressive posterior retinopathy of prematurity

Sukgen, Emine Alyamaç; Koçluk, Yusuf

doi:10.5935/0004-2749.20170009

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Original Articles • Arq. Bras. Oftalmol. 80 (1) • Jan-Feb 2017 • https://doi.org/10.5935/0004-2749.20170009 linkcopy

The vascularization process after intravitreal ranibizumab injections for aggressive posterior retinopathy of prematurity

Processo de vascularização após injeções intravítreas de ranibizumab para retinopatia da prematuridade posterior agressiva

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose: To evaluate the retinal vascularization process after intravitreal ranibizumab was administered to infants with aggressive posterior retinopathy of prematurity (AP-ROP).

Methods: Twenty-six eyes of 13 infants with AP-ROP who received 0.25 mg intravitreal ranibizumab were retrospectively investigated. The patients were evaluated at weekly follow-up visits, and the findings were analyzed after retinal vascularization was complete.

Results: The results showed regression in the AP-ROP of all the patients within the first 48-72 h. Average time for complete vascularization of the nasal quadrant (zone II) was postmenstrual week 45 (range 41-56), and vascularization of the temporal quadrant (zone III) was completed in the postmenstrual week 56 (range 50-65). Reactivation was observed in seven patients, on average at postmenstrual week 42; two of these patients underwent additional treatment. Two patients presented with avascular areas in the peripheral retina despite being 1 year old.

Conclusion: These results showed that retinal vascularization following intravitreal ranibizumab was completed after a delay in patients with AP-ROP. Further studies are necessary to evaluate when and how vascularization occurs after intravitreal anti-vascular endothelial growth factor treatments.

Keywords:
Retinopathy of prematurity/drug therapy; Retinal neovascularization/drug therapy; Intravitreal injections; Ranibizumab/therapeutic use; Child

Patient	Sex	Gestational age (weeks)	Birth weight (g)	Eye	Zone	Diagnosis	Rubeosis iridis	Postmenstrual age at treatment
Case 1	Male	30	1750	R	Zone II post	AP-ROP	-	38.5
				L	Zone II post		-
Case 2	Male	30	1400	R	Zone I	AP-ROP	-	34.0
				L	Zone I		-
Case 3	Male	29	1040	R	Zone II post	AP-ROP	+	36.0
				L	Zone II post		+
Case 4	Male	25	550	R	Zone I	AP-ROP	+	33.5
				L	Zone I		+
Case 5	Female	32	1600	R	Zone I	AP-ROP	+	37.0
				L	Zone I		+
Case 6	Female	26	640	R	Zone I	AP-ROP	-	34.0
				L	Zone I		-
Case 7	Female	29	1100	R	Zone II post	AP-ROP	-	34.0
				L	Zone II post		-
Case 8	Female	27	950	R	Zone I	AP-ROP	+	36.5
				L	Zone I		+
Case 9	Female	28	1150	R	Zone I	AP-ROP	+	36.0
				L	Zone I		+
Case 10	Male	31	1980	R	Zone I	AP-ROP	-	39.0
				L	Zone I		-
Case 11	Female	24	790	R	Zone I	AP-ROP	+	34.5
				L	Zone I		+
Case 12	Female	25	770	R	Zone I	AP-ROP	+	33.5
				L	Zone I		+
Case 13	Female	28	760	R	Zone I	AP-ROP	+	34.5
				L	Zone I		+

Patient	Postmenstruel age at treatment (weeks)	Age at recurrence (weeks)	Zone II completion of vascularization (weeks)	Zone III completion of vascularization (weeks)	Zone II vascularization speed (weeks)	Zone III vascularization speed (weeks)
Case 1	38.5	-	43.0	60.0	4.5	21.5
Case 2	34.0	42.0	41.0	59.0	7.0	25.0
Case 3	36.0	-	43.0	50.0	7.0	14.0
Case 4	33.5	43.0	42.0	54.0	8.5	20.5
Case 5	37.0	-	47.0	55.0	10.0	18.0
Case 6	34.0	43.0	51.0	65.0	7.0	31.0
Case 7	34.0	-	42.0	55.0	8.0	21.0
Case 8	36.5	-	42.0	54.0	5.5	17.5
Case 9	36.0	44.0	-	-	-	-
Case 10	39.0	-	45.0	50.0	6.0	11.0
Case 11	34.5	41.5	56.0	62.0	21.5	27.5
Case 12	33.5	41.0	46.5	56.0	13.0	22.5
Case 13	34.5	40.5	42.5	51.5	8.0	17.0

Patient	Age at treatment (weeks)	Age at recurrence (weeks)	Recurrence zone	Recurrence stage	Recurrence plus	Recurrence treatment	Age at recurrence treatment (weeks)
Case 2	34.0	42.0	Zone III	Stage 1	-	Spontaneous	-
Case 4	33.5	43.0	Zone III	Stage 1	-	Spontaneous	-
Case 6	34.0	43.0	Zone II	Stage 2-3	-	Spontaneous	-
Case 9	36.0	44.0	Zone II	Stage 1/2	-	Diode laser	47.0
Case 11	34.5	41.5	Zone II	Stage 2	+	Second dose	43.5
Case 12	33.5	41.0	Zone II	Stage 2	-	Spontaneous	-
Case 13	34.5	40.5	Zone II	Stage 1	-	Spontaneous	-

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[TFN1] AP-ROP= aggressive posterior retinopathy of prematurity; R= right eye; L= left eye.