Abstract
Objective
To investigate laser photocoagulation and intravitreal bevacizumab efficacy and safety in patients with moderate-to-severe stage 3 retinopathy of prematurity (ROP), and to evaluate the effects of treatment on the development of peripheral retinal vessels.
Methods
A retrospective chart review of 15 premature babies, all of whom were diagnosed with stage 3 ROP, was conducted. Patients with moderate-to-severe stage 3 ROP, thus with a vascular-active ROP, received intravitreal injections of bevacizumab (0.5 mg/0.02 ml) and laser photocoagulation, whereas those with relatively inactive ROP received laser photocoagulation only. Patients were examined 1, 2, 4, and 8 weeks after treatment, or until peripheral retinal vessel growth over the laser scar was noted.
Results
Both eyes of 15 patients diagnosed with moderate-to-severe stage 3 ROP were evaluated. Eight patients (n = 16 eyes) received intravitreal bevacizumab injection and laser photocoagulation, and seven patients (n = 14 eyes) received laser photocoagulation only. During the follow-up period, regression of plus disease and peripheral retinal vessel development appeared significantly more rapidly in patients who received both intravitreal bevacizumab injection and laser photocoagulation. Peripheral retinal vessel development over the laser scar was identified 1–2 weeks after treatment. No systemic or significant ocular complications, such as vitreous hemorrhage, retinal detachment, or endophthalmitis, were noted during follow-up after treatment.
Conclusions
A combination of laser photocoagulation and intravitreal bevacizumab injection seems to be a safe and effective therapy in patients with moderate-to-severe stage 3 ROP, promulgating rapid development of peripheral retinal vessels.
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References
Das A, McGuire PG (2003) Retinal and choroidal angiogenesis: pathophysiology and strategies for inhibition. Prog Retin Eye Res 22:721–748
Witmer AN, Vrensen GF, Van Noorden CJ, Schlingemann RO (2003) Vascular endothelial growth factors and angiogenesis in eye disease. Prog Retin Eye Res 22:1–29
Hartnett ME, McColm JR (2005) Diode laser for ROP. Ophthalmology 112:1636, author reply 1636
Chung EJ, Kim JH, Ahn HS, Koh HJ (2007) Combination of laser photocoagulation and intravitreal bevacizumab (Avastin) for aggressive zone I retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 245:1727–1730
Honda S, Hirabayashi H, Tsukahara Y, Negi A (2008) Acute contraction of the proliferative membrane after an intravitreal injection of bevacizumab for advanced retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 246:1061–1063
Lalwani GA, Berrocal AM, Murray TG, Buch M, Cardone S, Hess D, Johnson RA, Puliafito CA (2008) Off-label use of intravitreal bevacizumab (Avastin) for salvage treatment in progressive threshold retinopathy of prematurity. Retina 28:S13–S18
Mintz-Hittner HA, Kuffel RR Jr (2008) Intravitreal injection of bevacizumab (avastin) for treatment of stage 3 retinopathy of prematurity in zone I or posterior zone II. Retina 28:831–838
Quiroz-Mercado H, Martinez-Castellanos MA, Hernandez-Rojas ML, Salazar-Teran N, Chan RV (2008) Antiangiogenic therapy with intravitreal bevacizumab for retinopathy of prematurity. Retina 28:S19–S25
Spitzer MS, Wallenfels-Thilo B, Sierra A, Yoeruek E, Peters S, Henke-Fahle S, Bartz-Schmidt KU, Szurman P (2006) Antiproliferative and cytotoxic properties of bevacizumab on different ocular cells. Br J Ophthalmol 90:1316–1321
Olofsson B, Pajusola K, Kaipainen A, von Euler G, Joukov V, Saksela O, Orpana A, Pettersson RF, Alitalo K, Eriksson U (1996) Vascular endothelial growth factor B, a novel growth factor for endothelial cells. Proc Natl Acad Sci U S A 93:2576–2581
The International Classification of Retinopathy of Prematurity revisited (2005) The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 123:991–999
Wu WC, Lai CC, Chen KJ, Chen TL, Wang NK, Hwang YS, Yeung L, Li LM Long-term tolerability and serum concentration of bevacizumab (avastin) when injected in newborn rabbit eyes. Invest Ophthalmol Vis Sci
Smith LE (2008) Through the eyes of a child: understanding retinopathy through ROP. The Friedenwald lecture. Invest Ophthalmol Vis Sci 49:5177–5182
Park KH, Hwang JM, Choi MY, Yu YS, Chung H (2004) Retinal detachment of regressed retinopathy of prematurity in children aged 2 to 15 years. Retina 24:368–375
Hosseini H, Khalili MR, Nowroozizadeh S (2009) Intravitreal injection of bevacizumab (Avastin) for treatment of stage 3 retinopathy of prematurity in zone I or posterior zone II. Retina 29:562, author reply 562–564
Hartnett ME, Martiniuk D, Byfield G, Geisen P, Zeng G, Bautch VL (2008) Neutralizing VEGF decreases tortuosity and alters endothelial cell division orientation in arterioles and veins in a rat model of ROP: relevance to plus disease. Invest Ophthalmol Vis Sci 49:3107–3114
Kusaka S, Shima C, Wada K, Arahori H, Shimojyo H, Sato T, Fujikado T (2008) Efficacy of intravitreal injection of bevacizumab for severe retinopathy of prematurity: a pilot study. Br J Ophthalmol 92:1450–1455
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Lee, J.Y., Chae, J.B., Yang, S.J. et al. Effects of intravitreal bevacizumab and laser in retinopathy of prematurity therapy on the development of peripheral retinal vessels. Graefes Arch Clin Exp Ophthalmol 248, 1257–1262 (2010). https://doi.org/10.1007/s00417-010-1375-0
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DOI: https://doi.org/10.1007/s00417-010-1375-0