Combination of intravitreal injection of ranibizumab and laser photocoagulation for the treatment of aggressive posterior retinopathy of prematurity_Chinese Journal of Ocular Fundus Diseases

Authors：

XuYu , ZhangQi , JiXunda , 蔡璇 , 虞思伊 , 费萍 , 金海鹰 , 亢晓丽 ,  赵培泉

Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China;

Corresponding author：

赵培泉, Email: zhaopeiquan@126.com

Keywords：

Retinopathy of prematurity/therapy; Antibodies,monoclonal/therapeutic use; Laser coagulation

DOI：

10.3760/cma.j.issn.1005-1015.2014.01.008

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Objective To observe the efficacy and safety of combination of intravitreal injection of ranibizumab and laser photocoagulation for the treatment of aggressive posterior retinopathy of prematurity (AP-ROP). Methods Medical records of 70 eyes of 35 premature infants with a primary diagnosis of AP-ROP in our clinic were reviewed and analyzed retrospectively. All the lesions were located in posterior zone, with 42 eyes in zone 1 and 28 eyes in zone 2. Forty-six eyes had iris neovascularization, while 19 eyes combined with vitreous hemorrhage. All participants underwent intravitreal injection of ranibizumab as the primary treatment within 12 hours after diagnosis of AP-ROP. The systemic and ocular adverse effects were observed. The change of retinal vascular tortuosity and dilatation before and after the intravitreal injection of ranibizumab was observed one week after injection. Laser photocoagulation was used as adjuvant therapy if the plus disease persisted more than two weeks or new-onset ridge occurred after injection. The mean time interval between injection and laser therapy was (5.1±2.6) weeks (range, 1-10 weeks). Follow-up ranged from 6 to 18 months, with a mean of (10.3±3.9) months. The anatomical results and complications were evaluated after treatment. The eyes that progressed to stage 4 or 5 during the follow-ups were underwent lens-sparing vitrectomy or lensectomy combined with vitrectomy. Results No major systemic or ocular complications were observed. Preretinal hemorrhages were found in 12 eyes of 8 patients (17.1%), but they were absorbed spontaneously during the follow-ups. All lens remained transparent and no iatrogenic retinal hole was occurred during the follow-ups. After the injection, the regression of iris neovascularization was observed in 46 eyes within one week, vitreous hemorrhage absorbed significantly in 16 eyes (84.2%), and plus disease disappeared completely within one week in 61 eyes (87.1%). 59 eyes (84.3%) demonstrated vascularization toward the peripheral retina after treatment. 32 out of 42 eyes (76.2%) with zone 1 demonstrated vascularization toward to zone 2, while 24 out of 28 eyes (85.7%) with zone 2 demonstrated vascularization toward to the junction of zone 2 and 3. After intravitreal injection of ranibizumab combined with laser photocoagulation, 62 of 70 eyes (88.6%) had retinal vascular ridge and plus disease regression. However, 8 eyes of 6 patients (11.4%) showed significant fibrovascular proliferation and progressed to retinal detachment after the combination treatment of intravitreal ranibizumab injection and laser photocoagulation. Four eyes underwent lens-sparing vitrectomy, while the other 4 eyes underwent vitrectomy combined with lensectomy. Five eyes achieved totally retinal reattachment after surgery, while 3 eyes achieved partially retinal reattachment. Conclusion The combination of intravitreal injection of ranibizumab and laser photocoagulation is safe and effective in the treatment of AP-ROP.

Citation： XuYu, ZhangQi, JiXunda. Combination of intravitreal injection of ranibizumab and laser photocoagulation for the treatment of aggressive posterior retinopathy of prematurity. Chinese Journal of Ocular Fundus Diseases, 2014, 30(1): 28-32. doi: 10.3760/cma.j.issn.1005-1015.2014.01.008 Copy

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14.	Mintz-Hittner HA.Treatment of retinopathy of prematurity with vascular endothelial growth factor inibitors[J].Early Hum Dev,2012,88:937-941.
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19.	Bakri SJ, Snyder MR, Reid JM, et al.Pharmacokinetics of intravitreal bevacizumab (Avastin)[J].Ophthalmology,2007,114:855-859.

1. International Committee for the Classification of Retinopathy of Prematurity.The international classification of retinopathy of prematurity revisited[J].Arch Ophthalmol,2005,123:991-999.
2. Kychenthal A,Dorta P,Katz X.Zone Ⅰ retinopathy of prematurity:clinical characteristics and treatment outcomes[J].Retina,2006,26:11-15.
3. Hartbett ME,Penn JS.Mechanisms and management of retinopathy of prematurity[J].N Engl J Med,2012,367:2515-2526.
4. Bakri SJ, Snyder MR, Reid JM, et al.Pharmacokinetics of intravitreal ranibizumab (Lucentis)[J].Ophthalmology,2007,114:2179-2182.
5. Drenser KA,Trese MT,Capone A Jr.Aggressive posterior retinopathy of prematurity[J].Retina,2010,30:37-40.
6. Azuma N,Ishikawa K,Hama Y,et al.Early vitreous surgery for aggressive posterior retinopathy of prematurity[J].Am J Ophthalmol,2006,142:636-643.
7. Mataftsi A,Dimitrakos SA,Adams GG.Mediators involved in retinopathy of prematurity and emerging therapeutic targets[J].Early Hum Dev,2011,87:683-690.
8. 尹虹,黎晓新,梁建宏.激光光凝及抗血管内皮生长因子单克隆抗体bevacizumab玻璃体腔注射治疗早产儿视网膜病变的疗效观察[J].中华眼底病杂志,2012,28:15-17.
9. Nazari H,Modarres M,Parvaresh MM,et al.Intravitreal bevacizumab in combination with laser therapy for the treatment of severe retinopathy of prematurity (ROP) associated with vitreous or retinal hemorrhage[J].Graefe's Arch Exp Ophthalmol,2010,248:1713-1718.
10. Chung EJ,Kim JH,Ahn HS, et al.Combination of laser photocoagulation and intravitreal bevacizumab (Avastin) for aggressive zone I retinopathy of prematurity[J].Graefe's Arch Clin Exp Ophthalmol,2007,245:1727-1730.
11. Autrata R,Krejcírová I,Senková K,et al.Intravitreal pegaptanib combined with diode laser therapy for stage 3⁺ retinopathy of prematurity in zone I and posterior zone Ⅱ[J].Eur J Ophthalmol,2012,22:687-694.
12. Mintz-Hittner HA,Kennedy KA,Chuang AZ,et al.Efficacy of intravitreal bevacizumab for stage 3⁺ retinopathy of prematurity[J].N Engl J Med,2011,364:603-615.
13. 黄欣,单海冬,常青,等.急进性后部型早产儿视网膜病变的临床特征及治疗[J].中华眼底病杂志,2012,28:33-36.
14. Mintz-Hittner HA.Treatment of retinopathy of prematurity with vascular endothelial growth factor inibitors[J].Early Hum Dev,2012,88:937-941.
15. Castellanos MA,Schwartz S,García-Aguirre G,et al.Short-term outcome after intravitreal ranibizumab injections for the treatment of retinopathy of prematurity[J].Br J Ophthalmol,2013,97:816-819.
16. Kim MJ,Kim S,Yu YS.The risk for retinal detachment associated with hemorrhages pre and postlaser treatment in retinopathy of prematurity[J].Retina,2008,28:1451-1457.
17. Sanghi G, Dogra MR, Katoch D, et al.Aggressive posterior retinopathy of prematurity:risk factors for retinal detachment despite confluent laser photocoagulation[J]. Am J Ophthalmol, 2013,155:159-164.
18. Jang SY,Choi KS,Lee SJ.Delayed-onset retinal detachment after an intravitreal injection of ranibizumab for zone 1 plus retinopathy of prematurity[J].J AAPOS,2010,14:457-459.
19. Bakri SJ, Snyder MR, Reid JM, et al.Pharmacokinetics of intravitreal bevacizumab (Avastin)[J].Ophthalmology,2007,114:855-859.

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Combination of intravitreal injection of ranibizumab and laser photocoagulation for the treatment of aggressive posterior retinopathy of prematurity

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