INTRAVITREAL RANIBIZUMAB INJECTION AS TREATMENT IN PATIENTS WITH TYPE 1 RETINOPATHY OF PREMATURITY

Positive Response ◽

Primary Treatment ◽

Intravitreal Ranibizumab ◽

Response Group ◽

Aim: To investigate the anatomic outcomes of patients treated with intravitreal ranibizumab in the treatment of type 1 retinopathy of prematurity (ROP). A prospective cohort study was done including 100 eyes of Material And Method: 60 patients with type 1 ROP treated with intravitreal injection of ranibizumab (IVR) (0.25 mg/ 0.025 ml) as primary treatment from June 2018 to November 2019 over a period of 18 months. The anatomic outcomes were analyzed and follow-up were done upto 6 months. There were a Result: total of 94 eyes (94.0%) in the positive response group and 6 eyes (6.0%) in the negative/no response group after IVR. Within the positive response group, 49 eyes (52.13%) were in the regression without laser subgroup, and 45 eyes (47.87%) were in the regression with laser subgroup. Conclusion: Intravitreal injection of ranibizumab seemed to be effective in treating patients with type 1 ROP.

Optimised retinopathy of prematurity screening guideline in China based on a 5-year cohort study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-316401 ◽

2020 ◽

pp. bjophthalmol-2020-316401

Author(s):

Qian Yang ◽

Xiaohong Zhou ◽

Yingqin Ni ◽

Haidong Shan ◽

Wenjing Shi ◽

...

Keyword(s):

Cohort Study ◽

Neonatal Intensive Care ◽

Predictive Performance ◽

Screening Guideline ◽

Postmenstrual Age ◽

The Mean ◽

Type 1 Rop ◽

Rop Screening

PurposesTo develop an optimised retinopathy of prematurity (ROP) screening guideline by adjusting the screening schedule and thresholds of gestational age (GA) and birth weight (BW).MethodsA multicentre retrospective cohort study was conducted based on data from four tertiary neonatal intensive care units in Shanghai, China. The medical records of enrolled infants, born from 2012 to 2016 who underwent ROP examinations, were collected and analysed. The incidence and risk factors for ROP were analysed in all infants. Postnatal age (PNA) and postmenstrual age (PMA) of infants, detected to diagnose ROP for the first time, were compared with the present examination schedule. The predictive performance of screening models was evaluated by internally validating sensitivity and specificity.ResultsOf the 5606 eligible infants, ROP was diagnosed in 892 (15.9%) infants; 63 (1.1%) of them received treatment. The mean GA of ROP patients was 29.4±2.4 weeks, and the mean BW was 1260±330 g. Greater prematurity was associated with an older PNA at which ROP developed. The minimum PMA and PNA at which diagnosis of treatable ROP occurred were 32.43 and 3 weeks, respectively. The optimised criteria (GA <32 weeks or BW <1600 g) correctly predicted 98.4% type 1 ROP infants, reducing the infants requiring examinations by 43.2% when internally validated.ConclusionsThe incidence of type 1 ROP and the mean GA and BW of ROP infants have decreased in China. The suggested screening threshold and schedule may be reliably used to guide the modification of ROP screening guideline and decrease medical costs.

Systemic conbercept pharmacokinetics and VEGF pharmacodynamics following intravitreal injections of conbercept in patients with retinopathy of prematurity

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2021-319131 ◽

2021 ◽

pp. bjophthalmol-2021-319131

Author(s):

Yong Cheng ◽

Shuang Sun ◽

Xun Deng ◽

Xuemei Zhu ◽

Dandan Linghu ◽

...

Keyword(s):

Intravitreal Injections ◽

Vascular Endothelial ◽

Randomised Study ◽

Limit Of Quantitation ◽

Significant Difference ◽

Endothelial Growth Factor ◽

BackgroundData on serum vascular endothelial growth factor (VEGF) and drug levels in patients with retinopathy of prematurity (ROP) following intravitreal injections of conbercept (IVC) are lacking.MethodsMulticentre, prospective, non-randomised study of patients with aggressive posterior retinopathy of prematurity (APROP) or type 1 ROP who had not received other treatment. All infants received therapy in both eyes plus intravitreal IVC 0.25 mg/0.025 mL in one eye and had at least 6 months of follow-up. Blood samples were collected before and 1 week and 4 weeks after IVC. The main outcome measures were serum conbercept and VEGF concentrations.ResultsForty infants with APROP or type 1 ROP were enrolled. The mean serum VEGF at baseline and 1 week and 4 weeks after a total of 0.25 mg of IVC was 953.35±311.90 pg/mL, 303.46±181.89 pg/mL and 883.12±303.89 pg/mL, respectively. Serum VEGF 1 week after IVC was significantly lower (p<0.05) than baseline, and at 4 weeks after IVC, it was significantly higher (p<0.05) than at 1 week. There was no significant difference (p>0.05) between baseline and 4 weeks. Serum conbercept was below the limit of quantitation (BLOQ) at baseline and 4 weeks and was 19.81±7.60 ng/mL at 1 week.ConclusionSerum VEGF 1 week after IVC was significantly lower than baseline but returned to baseline at 4 weeks. Serum conbercept increased at 1 week and was BLOQ at 4 weeks.

Asymmetric Outcomes of Type 1 Retinopathy of Prematurity after Bilateral Intravitreal Ranibizumab Treatment

Journal of Ophthalmology ◽

10.1155/2017/1741386 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8

Author(s):

Qiujing Huang ◽

Qi Zhang ◽

Yu Xu ◽

Xunda Ji ◽

Ping Fei ◽

...

Keyword(s):

Retinal Detachment ◽

Vitreous Hemorrhage ◽

High Rate ◽

Intravitreal Ranibizumab ◽

Outcome Group ◽

Significant Difference ◽

Type 1 Rop ◽

Ranibizumab Treatment

Purpose. To present cases with retinopathy of prematurity (ROP), who were treated with intravitreal injection of ranibizumab (IVR) and had unpredictable asymmetric outcomes. Methods. A retrospective review was performed in infants with type 1 ROP and had bilateral IVR (0.25 mg/0.025 mL) as initial treatment. Patients were classified into the asymmetric outcome group and the symmetric outcome group. Results. Eighty-four patients (168 eyes) were included. There were 18 eyes of 9 patients (10.7%) in the asymmetric outcome group and 150 eyes of 75 patients (89.3%) in the symmetric outcome group. In the symmetric outcome group, 86 eyes (57.3%) had ROP regression, 60 eyes (40%) had reactivation requiring laser treatment, and 4 eyes (2.7%) progressed to retinal detachment requiring vitrectomy. In the asymmetric outcome group, one of the eyes of the 9 patients had ROP regression with/without reactivation after IVR, while the contralateral eyes had negative response, including remarkable posterior fibrosis, partial or total retinal detachment, and vitreous hemorrhage. There was statistically significant difference between the birth weight of the two groups. Conclusion. Contralateral eyes with ROP can take a different clinical course after ranibizumab treatment. High rate of reactivation after IVR is another concern that ophthalmologists should pay attention to.

Refractive and Biometric Outcomes in Patients with Retinopathy of Prematurity Treated with Intravitreal Injection of Ranibizumab as Compared with Bevacizumab: A Clinical Study of Correction at Three Years of Age

Journal of Ophthalmology ◽

10.1155/2018/4565216 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6

Author(s):

Yen-Chih Chen ◽

San-Ni Chen ◽

Benjamin Chi-Lan Yang ◽

Kun-Hsien Lee ◽

Chih-Chun Chuang ◽

...

Keyword(s):

Anterior Chamber ◽

Intravitreal Injection ◽

Refractive Error ◽

Anterior Chamber Depth ◽

Case Series ◽

Retrospective Case ◽

Type 1 Rop ◽

Birth Body Weight

Purpose. To compare refractive and biometric outcomes in patients with type 1 retinopathy of prematurity (ROP) treated with intravitreal injection of ranibizumab (IVR) versus bevacizumab (IVB), at a corrected age of 3 years. Methods. A retrospective case series compared cycloplegic refractive statuses and biometric statuses in patients who received either IVR or IVB for type 1 ROP, from April 2011 to April 2014. Results. A total of 62 eyes (33 patients) with type 1 ROP were evaluated (26 eyes in 13 IVR patients and 36 eyes in 20 IVB patients). There were no differences in birth statuses including gestational age and birth body weight between the two groups. The prevalence of refractive error greater than 1 D was higher in the IVB group (p=0.03), and there was a higher prevalence of high myopia (<−5.0 D, p=0.03) in the IVB group. Comparisons in biometric finding showed that IVB patients had shallower anterior chamber depth (p=0.01). Conclusion. Both IVR and IVB showed low refractive errors, even followed at the corrected age of 3 years. No difference was noted between the two groups in refractive statuses. However, IVB was associated with shallower anterior chamber and higher prevalence of refractive error at the corrected age of 3 years. This trial is registered with NCT03334513.

Combination of Intravitreal Injection of Ranibizumab and Photocoagulation for the Treatment of Aggressive Posterior Retinopathy of Prematurity with Vitreous Hemorrhage

Journal of Ophthalmology ◽

10.1155/2016/5029278 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6

Author(s):

Yu Xu ◽

Xiaoli Kang ◽

Qi Zhang ◽

Qiujing Huang ◽

Jiao Lv ◽

...

Keyword(s):

Laser Therapy ◽

Case Series ◽

Vitreous Hemorrhage ◽

Primary Treatment ◽

Intravitreal Ranibizumab ◽

Case Series Study ◽

The Mean ◽

Mean Time

To investigate the efficacy of intravitreal ranibizumab (IVR) combined with laser photocoagulation for aggressive posterior retinopathy of prematurity (AP-ROP) patients with vitreous hemorrhage, we conducted a retrospective observational case series study. A total of 37 eyes of 20 patients’ medical records were reviewed. Patients first received IVR (0.25 mg/0.025 mL) and later photocoagulation. The mean postconceptual age of injection was 34.6 ± 1.4 weeks, and the mean follow-up period was 39.3 ± 8.3 weeks. During the follow-up, 96.6% eyes had various degree of rapid absorption of vitreous hemorrhage after IVR. The mean time of received first photocoagulation after IVR was 4.8 ± 2.9 weeks. Ten (27.0%) eyes received second laser therapy and the mean time of second laser therapy after IVR was 3.2 ± 0.8 weeks. All eyes exhibited adequate regression of ROP and were stable with attached retina. Fibrosis membrane was observed in seven eyes (18.9%) and three of them demonstrated mild ectopic macula. No significant side effects related to IVR were observed. So IVR could be conducted as primary treatment of AP-ROP associated with vitreous hemorrhage, which can improve the fundus visibility, followed by conventional photocoagulation. Further randomized controlled trials are necessary to compare the clinical efficacy and safety with conventional interventions.

Preferences and Trends in Practices Caring Premature Infants for Retinopathy of Prematurity (ROP): A Web-based Survey

Current Trends in Ophthalmology ◽

10.18314/ctoy.v1i1.1247 ◽

2018 ◽

Vol 1 (1) ◽

pp. 49-61

Author(s):

Swati Agarwal-Sinha ◽

Sarina Amin ◽

Amanda Way

Keyword(s):

Premature Infants ◽

Laser Photocoagulation ◽

Practice Patterns ◽

Treatment Preferences ◽

Web Survey ◽

Web Based ◽

Objectives: To study preferences in treatment, follow-up and conclusion of examination in infants treated with and without bevacizumab (IVB) and/or laser photocoagulation for retinopathy of prematurity (ROP).Methods: A 22 question web survey was administered to physicians to understand practice patterns for treatment of type1 ROP, determine timeframe of conclusion of examinations with and without IVB/laser, and to approximate incidence of ROP recurrence post-treatment.Results: The survey revealed that 73% pediatric ophthalmologists reported not personally performing injections and 54.1% reported not performing laser. In infants with persistent avascular retina without pre-threshold disease, 54.2% continued examination > 50 weeks PMA, 23.3% discontinued at 50 weeks PMA, 3.2% preferred prophylactic laser and 5.1% fluorescein angiography and laser prior to concluding exams. 46.3% of physicians preferred IVB as primary monotherapy, 37.3% laser, and 16.4% both IVB and laser in type 1 ROP. Of those who preferred IVB, 20.4% concluded examination at ? 55 weeks PMA, whereas 79.6% continued evaluation >55 weeks PMA (60 to ? 80 weeks). Of those who preferred both IVB and laser, 50.6% concluded examination at ? 50 weeks PMA, whereas 49.4% continued > 50 weeks (60 to ? 80 weeks). 21.1 % of respondents reported recurrence with IVB and 8.8% with dual therapyConclusions: Treatment preferences and conclusion of examination in ROP varies considerably without and with treatment. Though a longer follow-up is recommended with IVB, this survey reveals extended examinations beyond 50 weeks PMA in infants with persistent avascular retina requiring no treatment and in the laser treated subgroup. The survey highlights low rates of performing treatments personally by pediatric ophthalmologists, and distinctlyvariable practice patterns in ROP care

Efficacy of ultra-low-dose (0.1 mg) ranibizumab intravitreal injection for treatment of prethreshold type 1 retinopathy of prematurity: A case series

European Journal of Ophthalmology ◽

10.1177/1120672118812266 ◽

2018 ◽

Vol 30 (1) ◽

pp. 40-47 ◽

Cited By ~ 2

Author(s):

Islam SH Ahmed ◽

Ahmed MA Hadi ◽

Hassan H Hassan

Keyword(s):

Side Effects ◽

Intravitreal Injection ◽

Large Scale ◽

Low Dose ◽

Case Series ◽

Results Of Treatment ◽

Case Series Study ◽

Systemic Side Effects

Aim: To report the results of treatment of type 1 prethreshold retinopathy of prematurity using intravitreal injection of ultra-low dose of ranibizumab (0.1 mg in 0.01 mL). Design: A retrospective observational case series study. Methods: Review of files of eligible infants who received this form of treatment to determine the outcome of treatment and any associated ocular or systemic side effects. Results: The study included 24 eyes of 12 preterm infants with mean gestational age of 29.75 ± 1.54 weeks and mean birth weight of 1074.58 ± 320.59 g. A total of 22 eyes (91.67%) had zone II disease while 2 eyes of one infant (8.33%) had zone I disease. All cases showed regression of the signs of the active retinopathy of prematurity with complete retinal vascularization. None of the cases required retreatment. Three eyes developed ocular complications. Apart from mild feeding intolerance that lasted for 24 h after injection in one infant, none of the cases developed systemic side effects. Conclusion: Intravitreal injection of ultra-low-dose ranibizumab showed promising efficacy and good ocular safety. However, further large-scale studies are required to give stronger evidence about the efficacy and safety of ultra-low-dose ranibizumab.

Evaluation of a deep learning image assessment system for detecting severe retinopathy of prematurity

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313156 ◽

2018 ◽

Vol 103 (5) ◽

pp. 580-584 ◽

Cited By ~ 20

Author(s):

Travis K Redd ◽

John Peter Campbell ◽

James M Brown ◽

Sang Jin Kim ◽

Susan Ostmo ◽

...

Keyword(s):

Deep Learning ◽

Predictive Value ◽

Severity Score ◽

Receiver Operating Curve ◽

Fundus Photography ◽

Image Analysis System ◽

Reference Standard ◽

BackgroundPrior work has demonstrated the near-perfect accuracy of a deep learning retinal image analysis system for diagnosing plus disease in retinopathy of prematurity (ROP). Here we assess the screening potential of this scoring system by determining its ability to detect all components of ROP diagnosis.MethodsClinical examination and fundus photography were performed at seven participating centres. A deep learning system was trained to detect plus disease, generating a quantitative assessment of retinal vascular abnormality (the i-ROP plus score) on a 1–9 scale. Overall ROP disease category was established using a consensus reference standard diagnosis combining clinical and image-based diagnosis. Experts then ranked ordered a second data set of 100 posterior images according to overall ROP severity.Results4861 examinations from 870 infants were analysed. 155 examinations (3%) had a reference standard diagnosis of type 1 ROP. The i-ROP deep learning (DL) vascular severity score had an area under the receiver operating curve of 0.960 for detecting type 1 ROP. Establishing a threshold i-ROP DL score of 3 conferred 94% sensitivity, 79% specificity, 13% positive predictive value and 99.7% negative predictive value for type 1 ROP. There was strong correlation between expert rank ordering of overall ROP severity and the i-ROP DL vascular severity score (Spearman correlation coefficient=0.93; p<0.0001).ConclusionThe i-ROP DL system accurately identifies diagnostic categories and overall disease severity in an automated fashion, after being trained only on posterior pole vascular morphology. These data provide proof of concept that a deep learning screening platform could improve objectivity of ROP diagnosis and accessibility of screening.

Incidence and Characteristics of Infants with Retinopathy of Prematurity in Croatia

Integrative Pediatrics and Child Care ◽

10.18314/ipcc.v1i1.1258 ◽

2018 ◽

Vol 1 (1) ◽

pp. 35-45

Author(s):

Mirjana Vucinovic ◽

Ljubo Znaor ◽

Ana Vucinovic ◽

Vesna Capkun ◽

Julijana Bandic

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Gestational Age ◽

Small For Gestational Age ◽

Neonatal Intensive Care ◽

PURPOSE: To study the incidence of retinopathy of prematurity (ROP) in a neonatal intensive care unit in Croatia and obtain information on risk factors associated with ROP. There have been limited studies on ROP in Croatia where the screening for ROP and its treatment is still insufficient and not introduced in many intensive care units. MATERIAL AND METHODS: This retrospective study included 247 premature infants admitted to the neonatal intensive care unit of University Hospital Split, over a 5-year period between January 2012, and December 2016. In this paper the relationship between clinical risk factors and the development of ROP was analyzed. RESULTS: The overall incidence for ROP was 23,9 % (59 infants), for Type 1 ROP was 9,3% (23 infants); for Type 2 ROP was 14,6% (36 infants). Median gestational age (GA) and birthweight (BW) were significantly lower among infants with ROP versus those without ROP (29: 23-34 vs. 31: 23-34,p<0,001 and 1,180:630-2,000 vs. 1485:590-2000, p<0,001 respectively). Multivariate analysis showed that only BW (p=0,029) and small for gestational age (SGA) (p=0,045) predicted the development of ROP. CONCLUSION: Birth weight and small for gestational age were the most significant risk factors for developing ROP. In comparison with studies from highly developed countries, infants with a much wider range of gestational age and birth weights are developing Type 1 ROP.