Intravitreal Injection of Bevacizumab for Retinopathy of Prematurity in an Infant with Peters Anomaly

Abstract

Purpose: To report our findings in an infant with Peters anomaly type II whose retinopathy of prematurity (ROP) was treated with an anti-VEGF agent and surgeries. Case Report: A male infant weighing 548 g was born prematurely at 23 weeks and 1 day with corneal opacity and shallow anterior chambers in both eyes. At the postmenstrual age of 35 weeks and 3 days, the infant was tentatively diagnosed with stage 3 ROP because of a dilated tunica vasculosa lentis and ultrasonographic findings. The boy was treated with bilateral intravitreal injections of bevacizumab (IVB) because laser photocoagulation of the retina could not be performed due to the corneal opacity. The retina in the right eye detached 3 times, namely 5 days, 16 days, and 7 months after the IVB; encircling the scleral buckle and a vitrectomy with endolaser photocoagulation were therefore required. In his left eye, the retina was reattached after the initial IVB, and no additional treatment was required. ROP was not reactivated in both eyes until the last examination at the age of 2 years and 6 months. Conclusions: Our results showed that IVB is a useful treatment for ROP in patients with Peters anomaly. However, a retinal detachment can be a complication after IVB. The optimal timing of IVB for ROP in infants with hazy media needs to be determined.

Pharmacologic interventions for the prevention and treatment of retinopathy of prematurity

“…This was demonstrated by Hu et al (151). Studies have since tried to address safety of intravitreal bevacizumab use in ROP and demonstrated numerous acute and latent retinal adverse effects (151)(152)(153)(154)(155)(156)(157)(158)(159)(160)(161)(162)(163)(164)(165)(166)(167)(168). Interestingly, serum concentrations of bevacizumab concurrent with suppressed systemic VEGF levels lasted up to 60 days post intravitreal administration (169)(170)(171)(172), and the levels were significantly lower than previously reported in preterm infants (173).…”

A Systematic Review and Meta-Analysis on the Safety of Vascular Endothelial Growth Factor (VEGF) Inhibitors for the Treatment of Retinopathy of Prematurity

“…There was one case report of spontaneous reattachment [51]. Especially important are the reports of initial regression with delayed recurrent neovascularization after bevacizumab (with or without laser photocoagulation), which occurred up to 19 weeks after intravitreal injection [52–57].…”

“…In the studies, which were not included in this papers quantitative analysis, the most frequent reported ocular complication was retinal detachment requiring treatment after intravitreal injection of VEGF inhibitors [ 43 – 50 ]. There was one case report of spontaneous reattachment [ 51 ]. Especially important are the reports of initial regression with delayed recurrent neovascularization after bevacizumab (with or without laser photocoagulation), which occurred up to 19 weeks after intravitreal injection [ 52 – 57 ].…”

“…Other serious side effects included acute contraction of proliferative membrane [ 44 , 58 – 59 ], vascular sheathing [ 57 ], choroidal ischemia [ 60 ], optic atrophy [ 61 ], disc pallor [ 62 ], retinal break, RPE rupture [ 61 ] and choroidal rupture [ 63 ], which all occurred after bevacizumab combined with laser photocoagulation. Less severe side effects were cataract [ 51 , 57 ], increased IOP [ 51 , 64 ] and mild vitreous organization [ 65 ].…”