Effects of intravitreal ranibizumab for the treatment of retinopathy of prematurity_Chinese Journal of Ocular Fundus Diseases

Authors：

SunXiantao , ChenChangzheng ,  陈长征 , 郑红梅 , 余岚

Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China;

Corresponding author：

陈长征, Email: whuchenchzh@163.com

Keywords：

Retinopathy of prematurity/drug therapy; Angiogenesis inhibitors/therapeutic use; Antibodies; monoclonal/therapeutic use

DOI：

10.3760/cma.j.issn.1005-1015.2015.01.004

Video：

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Objective To evaluate the efficacy and safety of intravitreal ranibizumab (IVR) for the treatment of retinopathy of prematurity(ROP). Methods A total of 57 eyes of 29 premature infants with diagnosis of high-risk pre-threshold, threshold ROP, or aggressive posterior ROP were reviewed and analyzed in the study. The lesions of 18 eyes were located in zoneⅠ, 39 eyes were located in zoneⅡ. All infants in the study received IVR (10 mg/ml, 0.025 ml) as the initial treatment within 24 hours after diagnosis. Follow-up examinations were performed after treatment, every week at the first month, every 2 weeks at the second and third month, every month afterward, until vascularization of zoneⅢwas observed. Follow-up ranged from 16 weeks to 52 weeks, and the average follow-up time was (28.1±11.7) weeks. If the infants didn't respond positively to the treatment or the disease recurred, the additional treatments were applied. 36 eyes (63.2%) received a single injection, whereas 21 eyes (36.8%) received additional treatments. The follow-up examinations included the development of retinal vessels, the ocular or systemic adverse events. Results Among the eyes, the development of peripheral retinal vessels could be observed in 36 eyes (63.2%) which received a single injection; clinical improvement in 11 eye (19.3%) which received repeat injection; stable disease in 10 eyes (17.5%) which received laser therapy. Among the eyes, 18 eyes (31.6%) recurred, including ggressive posterior ROP (14 eyes), threshold ROP (2 eyes) and high-risk pre-threshold ROP (2 eyes). The mean time of recurrence was (5.7±2.1) weeks (range 2.0-8.0 weeks). Three eyes (5.3%) of high-risk pre-threshold, threshold ROP lacked a positive response to the treatment. The lesions were controlled after additional laser given in these eyes. No serious ocular or systemic adverse events associated with the drug or the injection was observed during the follow-up period. Conclusion IVR is safe and effective for most ROP infants. In cases of recurrence or no response, conventional laser treatment or an additional IVR injection were needed.

Citation： SunXiantao, ChenChangzheng. Effects of intravitreal ranibizumab for the treatment of retinopathy of prematurity. Chinese Journal of Ocular Fundus Diseases, 2015, 31(1): 10-13. doi: 10.3760/cma.j.issn.1005-1015.2015.01.004 Copy

1.	Spandau U, Tomic Z, Ewald U, et al. Time to consider a new treatment protocol for aggressive posterior retinopathy of prematurity[J]. Acta Ophthalmol, 2013, 91(2):170-175.
2.	Shah PK, Narendran V, Tawansy KA, et al. Intravitreal bevacizumab (Avastin) for post laser anterior segment ischemia in aggressive posterior retinopathy of prematurity[J]. Indian J Ophthalmol, 2007, 55(1):75-76.
3.	Lalwani GA, Berrocal AM, Murray TG, et al. Off-label use of intravitreal bevacizumab (Avastin) for salvage treatment in progressive threshold retinopathy of prematurity[J]. Retina, 2008, 28(Supple 3):S13-18.
4.	Micieli JA, Surkont M, Smith AF. A systematic analysis of the off-label use of bevacizumab for severe retinopathy of prematurity[J]. Am J Ophthalmol, 2009, 148(4):536-543.
5.	Wu WC, Kuo HK, Yeh PT, et al. An updated study of the use of bevacizumab in the treatment of patients with prethreshold retinopathy of prematurity in Taiwan[J]. Am J Ophthalmol, 2013, 155(1):150-158.
6.	Chung EJ, Kim JH, Ahn HS, et al. Combination of laser photocoagulation and intravitreal bevacizumab (Avastin) for aggressive zoneⅠretinopathy of prematurity[J]. Graefe's Arch Clin Exp Ophthalmol, 2007, 245(11):1727-1730.
7.	Martínez-Castellanos MA, Schwartz S, Hernández-Rojas ML, et al. Long-term effect of antiangiogenic therapy for retinopathy of prematurity up to 5 years of follow-up[J]. Retina, 2013, 33(2):329-338.
8.	Wu WC, Yeh PT, Chen SN, et al. Effects and complications of bevacizumab use in patients with retinopathy of prematurity:a multicenter study in Taiwan[J]. Ophthalmology, 2011, 118(1):176-183.
9.	Hu J, Blair MP, Shapiro MJ, et al. Reactivation of retinopathy of prematurity after bevacizumab injection[J]. Arch Ophthalmol, 2012, 130(8):1000-1006.
10.	许宇, 张琦, 季迅达, 等.玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab联合激光光凝治疗急进性后部型早产儿视网膜病变的疗效观察[J].中华眼底病杂志, 2014, 30(1):28-32.
11.	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(1):15-17.
12.	张国明, 唐松, 曾键, 等.早产儿视网膜病变激光光凝辅助玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab治疗临床疗效观察[J].中华眼底病杂志, 2012, 28(1):18-21.
13.	International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited[J]. Arch Ophthalmol, 2005, 123(7):991-999.
14.	Mintz-Hittner HA. Treatment of retinopathy of prematurity with vascular endothelial growth factor inhibitors[J]. Early Hum Dev, 2012, 88(12):937-941.
15.	Early Treatment for Retinopathy of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity:results of the early treatment for retinopathy of prematurity randomized trial[J]. Arch Ophthalmol, 2003, 121(12):1684-1694.
16.	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(7):603-615.
17.	Mintz-Hittner HA, Kuffel RR Jr. Intravitreal injection of bevacizumab (avastin) for treatment of stage 3 retinopathy of prematurity in zoneⅠor posterior zoneⅡ[J]. Retina, 2008, 28(6):831-838.
18.	Sato T, Kusaka S, Shimojo H, et al. Vitreous levels of erythropoietin and vascular endothelial growth factor in eyes with retinopathy of prematurity[J]. Ophthalmology, 2009, 116(9):1599-1603.

1. Spandau U, Tomic Z, Ewald U, et al. Time to consider a new treatment protocol for aggressive posterior retinopathy of prematurity[J]. Acta Ophthalmol, 2013, 91(2):170-175.
2. Shah PK, Narendran V, Tawansy KA, et al. Intravitreal bevacizumab (Avastin) for post laser anterior segment ischemia in aggressive posterior retinopathy of prematurity[J]. Indian J Ophthalmol, 2007, 55(1):75-76.
3. Lalwani GA, Berrocal AM, Murray TG, et al. Off-label use of intravitreal bevacizumab (Avastin) for salvage treatment in progressive threshold retinopathy of prematurity[J]. Retina, 2008, 28(Supple 3):S13-18.
4. Micieli JA, Surkont M, Smith AF. A systematic analysis of the off-label use of bevacizumab for severe retinopathy of prematurity[J]. Am J Ophthalmol, 2009, 148(4):536-543.
5. Wu WC, Kuo HK, Yeh PT, et al. An updated study of the use of bevacizumab in the treatment of patients with prethreshold retinopathy of prematurity in Taiwan[J]. Am J Ophthalmol, 2013, 155(1):150-158.
6. Chung EJ, Kim JH, Ahn HS, et al. Combination of laser photocoagulation and intravitreal bevacizumab (Avastin) for aggressive zoneⅠretinopathy of prematurity[J]. Graefe's Arch Clin Exp Ophthalmol, 2007, 245(11):1727-1730.
7. Martínez-Castellanos MA, Schwartz S, Hernández-Rojas ML, et al. Long-term effect of antiangiogenic therapy for retinopathy of prematurity up to 5 years of follow-up[J]. Retina, 2013, 33(2):329-338.
8. Wu WC, Yeh PT, Chen SN, et al. Effects and complications of bevacizumab use in patients with retinopathy of prematurity:a multicenter study in Taiwan[J]. Ophthalmology, 2011, 118(1):176-183.
9. Hu J, Blair MP, Shapiro MJ, et al. Reactivation of retinopathy of prematurity after bevacizumab injection[J]. Arch Ophthalmol, 2012, 130(8):1000-1006.
10. 许宇, 张琦, 季迅达, 等.玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab联合激光光凝治疗急进性后部型早产儿视网膜病变的疗效观察[J].中华眼底病杂志, 2014, 30(1):28-32.
11. 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(1):15-17.
12. 张国明, 唐松, 曾键, 等.早产儿视网膜病变激光光凝辅助玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab治疗临床疗效观察[J].中华眼底病杂志, 2012, 28(1):18-21.
13. International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited[J]. Arch Ophthalmol, 2005, 123(7):991-999.
14. Mintz-Hittner HA. Treatment of retinopathy of prematurity with vascular endothelial growth factor inhibitors[J]. Early Hum Dev, 2012, 88(12):937-941.
15. Early Treatment for Retinopathy of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity:results of the early treatment for retinopathy of prematurity randomized trial[J]. Arch Ophthalmol, 2003, 121(12):1684-1694.
16. 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(7):603-615.
17. Mintz-Hittner HA, Kuffel RR Jr. Intravitreal injection of bevacizumab (avastin) for treatment of stage 3 retinopathy of prematurity in zoneⅠor posterior zoneⅡ[J]. Retina, 2008, 28(6):831-838.
18. Sato T, Kusaka S, Shimojo H, et al. Vitreous levels of erythropoietin and vascular endothelial growth factor in eyes with retinopathy of prematurity[J]. Ophthalmology, 2009, 116(9):1599-1603.

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Effects of intravitreal ranibizumab for the treatment of retinopathy of prematurity

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