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Characteristics of ‘sawtooth shunt’ following anti-vascular endothelial growth factor for aggressive posterior retinopathy of prematurity

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Abstract

Objective

To explore the characteristics of ‘sawtooth shunts (STS)’ following intravitreal anti-vascular endothelial growth factors (anti-VEGF) for aggressive posterior retinopathy of prematurity (AP-ROP).

Design

Prospective observational study.

Methods

In a prospective observational study, 45 eyes of 24 babies receiving intravitreal anti-VEGF for AP-ROP or hybrid ROP were analyzed. Anti-VEGF molecule and doses: bevacizumab (0.62 mg or ½ IVB, n = 30 eyes; 0.25 mg or 1/5IVB, n = 9 eyes; 0.12 mg or 1/10 IVB, n = 1 eye); or ranibizumab (0.25 mg or ½IVR, n = 3 eyes; 0.1 mg or 1/5IVR, n = 2 eyes). They were followed every 1–2 week till disease regression with or without laser treatment. Development of STS, its variants, characteristics, timeline, and final outcomes was analyzed.

Results

STS occurred in 26 (57.7%) eyes at 1–6 weeks following anti-VEGF injections and persisted for 1–14 weeks. While the shunt regressed spontaneously in half of the treated eyes (n = 13) with anti-VEGF alone, the other half (n = 13) required additional laser because of either non-compliance (n = 9) or recurrence (n = 4).

Conclusion

The STS was observed to be an important retinal vascular change seen in infants treated with intravitreal anti-VEGF at half adult doses. It warrants further studies to explore the association between STS and its association with disease recurrence or regression.

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Funding

There is no direct support or grant related to this piece of work. However, the authors belong to an institute that receives support from Queen Elizabeth Diamond Jubilee Trust (UK), Miriam Hyman Memorial Trust (UK), Rastriya Bal Swasthya Karyakram (RBSK), and Dalmia holdings in India for its ongoing ROP work.

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Authors and Affiliations

  1. Faculty, Vitreoretinal Services, LV Prasad Eye Institute, Mithu Tulsi Chanrai (MTC) Campus, Patia, Bhubaneswar, 751024, India

    Tapas Ranjan Padhi, Prabhjot Kaur, Samir Sutar, Ashish Khalsa & Rohit Modi

  2. Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India

    Taraprasad Das & Subhadra Jalali

  3. Department of Biostatistics, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India

    Hasnat Ali

  4. Department of Pediatrics, Infosys Pediatric Department, Capital Hospital, Bhubaneswar, India

    Lingaraj Pradhan

Authors
  1. Tapas Ranjan Padhi
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  2. Taraprasad Das
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  3. Prabhjot Kaur
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  4. Samir Sutar
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  5. Ashish Khalsa
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  6. Rohit Modi
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  7. Hasnat Ali
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  8. Lingaraj Pradhan
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  9. Subhadra Jalali
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Tapas Ranjan Padhi, Prabhjot Kaur, and Ashish Khalsa. The first draft of the manuscript was written by Tapas Ranjan Padhi, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Tapas Ranjan Padhi.

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Padhi, T.R., Das, T., Kaur, P. et al. Characteristics of ‘sawtooth shunt’ following anti-vascular endothelial growth factor for aggressive posterior retinopathy of prematurity. Int Ophthalmol 40, 1007–1015 (2020). https://doi.org/10.1007/s10792-019-01269-4

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  • DOI: https://doi.org/10.1007/s10792-019-01269-4

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