Significant Treatment Failure With Intravitreous Bevacizumab for Retinopathy of Prematurity

Patel, Riddhi; Blair, Michael P.; Shapiro, Michael J.; Lichtenstein, Steven J.

doi:10.1001/archophthalmol.2011.1802

Cited by 57 publications

(35 citation statements)

References 4 publications

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“…We demonstrated total disease regression with successful anatomical outcomes in all infants who received IVB as a single treatment modality for APROP (Figure 4). Further, there have been a number of reports of disease recurrence after 54 weeks of PMA following IVB injection indicating a need for longer follow-up until at least 70 weeks of PMA (24,25) . It has also been suggested that aggressive cases may require additional IVB injections to prevent disease recurrence (6,25) .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of 2-year outcomes following intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity

Günay¹,

Çelik²,

Günay³

et al. 2015

Arquivos Brasileiros De Oftalmologia

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Approved by the following research ethics committee: Zeynep Kamil Maternity and Children's Disease Training and Research Hospital. ABSTRACTPurpose: To evaluate 2-year outcomes following intravitreal bevacizumab (IVB) as monotherapy for aggressive posterior retinopathy of prematurity (APROP). Methods: Medical records of 40 infants were retrospectively reviewed. Group I included infants who had received IVB injections for APROP. Group II included infants who underwent laser treatment for APROP. Anatomic and refractive outcomes and the presence of anisometropia and strabismus were assessed at follow-up examinations. Results: Group I included 48 eyes of 25 infants (11 males) with a mean gestational age (GA) of 26.40 ± 1.82 weeks and a mean birth weight (BW) of 901.40 ± 304.60 g. Group II included 30 eyes of 15 infants (6 males) with a mean GA of 27.30 ± 1.82 weeks and a mean BW of 941.00 ± 282.48 g. GA, BW, and gender distributions were similar between groups (P=0.187, P=0.685, and P=1.000, respectively). Refractive errors were significantly less myopic in group I (0.42 ± 3.42 D) than in group II (-6.66 ± 4.96 D) at 2 years (P=0.001). Significantly higher rates of anisometropia and strabismus were observed in group II than in group I (P=0.009 and P=0.036, respectively). Conclusions:The study demonstrated that IVB monotherapy can be useful in the treatment of APROP. The decreased incidence of early unfavorable refractive and functional outcomes in the IVB group compared with the laser group showed a potential benefit for patients treated with IVB, and this needs to be better evaluated in future prospective studies.

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Section: Discussionmentioning

confidence: 99%

Evaluation of 2-year outcomes following intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity

Günay¹,

Çelik²,

Günay³

et al. 2015

Arquivos Brasileiros De Oftalmologia

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“…Bevacizumab leaks into the systemic circulation and reduces systemic VEGF concentrations [49]. Follow-up of infants treated with intravitreal bevacizumab through 60 weeks' PMA found complications including persistent peripheral avascular retina, new intravitreal neovascularization, retinal detachment and macular dragging [50,51]. Reduced serum VEGF has been reported 2 weeks after intravitreal injection of bevacizumab or ranibizumab [52,53].…”

Section: Anti-vegf Antibodymentioning

confidence: 99%

Retinopathy of Prematurity: Therapeutic Strategies Based on Pathophysiology

Cayabyab¹,

Ramanathan²

2016

Neonatology

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Retinopathy of prematurity (ROP) continues to be a major preventable cause of blindness and visual handicaps globally. With improved perinatal care, improved survival of moderately preterm infants, and limited resources for oxygen delivery and monitoring, more mature preterm infants are developing severe ROP in developing countries. The pathophysiology of ROP is characterized by two phases. Phase I ROP is due to vaso-obliteration beginning immediately after birth secondary to a marked decrease in vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1). Phase II begins around 33 weeks' postmenstrual age (PMA). During this phase, VEGF levels increase, especially if there is retinal hypoxia with increasing retinal metabolism and demand for oxygen leading to abnormal vasoproliferation. Since the original description of ROP in 1942 by Terry et al. [Am J Ophthalmol 1942;25:203-204], four epidemics of ROP have been observed. Prevention or early treatment of ROP involves careful titration of oxygen saturation by pulse oximeter (SpO₂). Optimal SpO₂ target remains elusive. Most of the large trials have focused on either a low SpO₂ (85-89%) or a high SpO₂ (91-95%) from the first day of birth to 36 weeks' PMA. Although the incidence of severe ROP and bronchopulmonary dysplasia decreased significantly, predischarge mortality was higher in these studies. Use of graded SpO₂ during the 2 different phases of ROP (early, low SpO₂ during phase I vs. late, high SpO₂ during phase II) may be the best approach to prevent this disabling condition. Further trials should focus on this strategy. Other biological agents that are currently being studied include IGF-1 with IGF-binding protein-3 (rhIGF-1 + rhIGFBP-3) and propranolol. For advanced stages of ROP, laser ablation of avascular retina, early treatment of ROP (ETROP) protocol, intravitreal injection of anti-VEGF antibodies (e.g. bevacizumab) and vitrectomy are used to protect central vision and prevent retinal detachment. Long-term complications such as refractory errors, recurrence of ROP and risk of retinal detachment require continued follow-up with an ophthalmologist through adolescence and beyond. Optimal nutrition including adequate intake of omega-3 polyunsaturated fatty acids and decreasing infection/inflammation to promote normal vascularization are important strategies. Screening guidelines for ROP based on local incidence of ROP in different regions of the world are very important. Oxygen therapy is clearly a modifiable risk factor to decrease ROP that needs further study. Understanding the two phases of ROP will help to identify appropriate therapeutic strategies and improve visual outcomes in many preterm infants globally.

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“…There is limited information on how anti-VEGF treatment affects the vascularization of the peripheral retina in patients with ROP who have largely avascular retina. Some complications such as persistent avascular retina, recurrent intravitreal angiogenesis, and stage 5 retinal detachments have been reported after a single IVI of bevacizumab [17,18]. Therefore, after receiving IVB as primary treatment for ROP, infants should be monitored closely until complete retinal vascularization is observed [10].…”

Section: Discussionmentioning

confidence: 99%

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

Sukgen

Çömez²,

Koçluk³

et al. 2016

Ophthalmologica

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Purpose: To compare the effects on the process of retinal vascularization of intravitreal ranibizumab (IVR) and intravitreal bevacizumab (IVB) in the treatment of severe retinopathy of prematurity. Methods: The present study is a bi-centered retrospective study. While 44 eyes of 22 patients in group 1 were applied 0.625 mg bevacizumab, 46 eyes of 23 patients in group 2 were applied 0.25 mg ranibizumab. Retinal vascularization was evaluated clinically. Results: The mean time for completion of vascularization was found to be postmenstrual 55.93 ± 4.13 weeks in group 1 and 56.30 ± 4.30 weeks in group 2. There were signiﬁcant differences in the recurrence prevalence between the two groups. The prevalence of recurrence was found to be significantly higher in the ranibizumab group than in the bevacizumab group (p = 0.023). Conclusions: The study showed that after IVR or IVB treatment, vascularization could be completed with delay; there were no differences in this delay time between the ranibizumab and bevacizumab groups. Besides, avascular areas may remain in the peripheral retina, and additional treatment may be necessary after IVB or IVR treatment. When the treatment was applied as monotherapy, more recurrence was observed in the ranibizumab group.

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Significant Treatment Failure With Intravitreous Bevacizumab for Retinopathy of Prematurity

Cited by 57 publications

References 4 publications

Evaluation of 2-year outcomes following intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity

Evaluation of 2-year outcomes following intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity

Retinopathy of Prematurity: Therapeutic Strategies Based on Pathophysiology

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

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