Combination of Intravitreal Ranibizumab and Laser Photocoagulation for Aggressive Posterior Retinopathy of Prematurity

Abstract

Purpose: To report on 2 cases of aggressive posterior retinopathy of prematurity (ROP) treated with intravitreal ranibizumab (Lucentis®) and laser photocoagulation. Methods: Two premature females, born at 25 and 26 weeks’ gestation with a birth weight of 530 and 550 g, respectively, with aggressive posterior ROP received combined treatment with laser photocoagulation and intravitreal ranibizumab (0.3 mg [30 µl]) to each eye. Structural outcomes were evaluated by indirect ophthalmoscopy and documented by retinography. Results: An intravitreal injection was made at 34 weeks of postmenstrual age in the first case, followed by laser photocoagulation 1 week later. There was a partial regression of ROP with treatment. Five weeks later, neovascularization regrowth with bleeding in both eyes (intraretinal and subhyaloid) occurred and retreatment with combined therapy was performed. In the second case, single therapy with laser photocoagulation was made at 34 weeks of postmenstrual age. In spite of the confluent photocoagulation in the avascular area, progression to 4A ROP stage occurred 1 week later. Both eyes were retreated 1 week later with intravitreal ranibizumab and laser photocoagulation. Treatment resulted in ROP regression in both cases. There were no signs of systemic or ocular adverse side effects. Conclusion: The cases presented show that combination therapy of indirect laser photocoagulation and intravitreal ranibizumab can be effective in the management of aggressive posterior ROP. Further investigation on anti-VEGF safety in premature infants is necessary . Additional studies are needed to define the role of anti-VEGF in ROP treatment.

Comparison of intravitreal ranibizumab and bevacizumab treatment for retinopathy of prematurity

“…The aim of laser photocoagulation is to decrease VEGF levels produced by the avascular retina by ablating the retinal periphery. Lately, anti-VEGF drugs have been used as monotherapy agents or in addition to laser photocoagulation, with successful results obtained (7)(8)(9)(11)(12)(13)(14)(15)(16) . The majority of studies have reported the results of bevacizumab therapy.…”

“…The majority of studies have reported the results of bevacizumab therapy. There are a few case series presenting results with ranibizumab (7,8) . Although there are stu dies comparing the efficacy of ranibizumab and bevacizumab in patients with age-related macular degeneration, to the best of our knowledge, the present study is the first to compare their efficacy in patients with ROP (17) .…”

“…In the Bevacizumab Eliminates the Angiogenic Threat of Retinopathy of Prematurity (BEAT-ROP) study, bevacizumab treatment was found to be more effective than laser photocoagulation for ROP treatment, particularly in patients with zone 1 and 2 posterior disease (6) . Moreover, other anti-VEGF the rapies, macugen and ranibizumab, demonstrated efficacy in the treatment of ROP when used alone or in combination with laser photocoagulation (7)(8)(9) .…”

Terapia anti-angiogénica con ranibizumab en el tratamiento de retinopatía de la prematuridad

“…Jang et al, (21) reportaron un paciente con ROP estadio 3 en zona I bilateral que fue tratado con termoterapia transpupilar láser más ranibizumab, con regresión completa 3 meses después del tratamiento pero con desprendimiento de retina bilateral después de este tiempo. Honda et al, informaron en un paciente contracción aguda de la membrana proliferativa que dio lugar a desprendimiento de retina en forma de embudo después de bevacizumab intravítreo para ROP etapa 4A (22), lo que indica la importancia del seguimiento estrecho (23).…”

The Process of Retinal Vascularization after Anti-VEGF Treatment in Retinopathy of Prematurity: A Comparison Study between Ranibizumab and Bevacizumab

“…The use of anti-vascular endothelial growth factor (anti-VEGF) agents is a current treatment option for ROP. Bevacizumab (Avastin; Genentech Inc., San Francisco, Calif., USA) and ranibizumab (Lucentis; Genentech Inc.) are two anti-VEGF agents with different molecular sizes, structures, and half-lives, and both of them have shown efficacy in the treatment of ROP [3,4,5,6]. However, preterm babies have incomplete retinal vascular development and areas of peripheral avascular retina.…”