Angiographic findings in cases with a history of severe retinopathy of prematurity treated with anti-VEGFs: Follow-up to age 6 years

Comparing safety and efficacy of Bevacizumab, Ranibizumab and Ranibizumab biosimilar in Retinopathy of prematurity

PURPOSE

To compare the safety and efficacy of Bevacizumab, Ranibizumab and Ranibizumab biosimilar in treatment of Retinopathy of prematurity (ROP) METHODS: Retrospective study that included newborns with type 1 ROP who received intravitreal Bevacizumab (Avastin) or Ranibizumab (Accentrix) or Ranibizumab biosimilar (Razumab). Babies were followed up as per protocol and retreatment with laser or repeat anti vascular endothelial growth factor (VEGF) was done in case of reactivation and surgery in case of progression to traction. Outcome measures include need for retreatment, proportion of eyes achieving vascularization up to ora and adverse events RESULTS: 148 eyes of 75 babies, received intravitreal injection of which 139 eyes of 70 babies were included in our analysis. 68 eyes received bevacizumab (IVB), 31 eyes received Accentrix (IVA), 40 eyes received Razumab(IVR). The rate of retreatment was 17.6%, 32.2% and 25% for IVB, IVA and IVR respectively (p = 0.1). IVB group showed a significantly delayed reactivation (p < 0.001), while Ranibizumab and its biosimilar Razumab were comparable (p = 0.17). Vascularization up to ora was observed in 60%, 61% and 50% eyes (p = 0.76) at a median of 27, 28 and 24 weeks post-treatment (p = 0.09) in IVB, IVA and IVR groups respectively. No eyes developed intraocular inflammation or cataract.

CONCLUSION

All three drugs were similar in their efficacy and safety profile with bevacizumab showing a later reactivation.

FLUORESCEIN ANGIOGRAPHY EVALUATION OF CHILDREN PREVIOUSLY TREATED WITH ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR MONOTHERAPY FOR RETINOPATHY OF PREMATURITY

PURPOSE

To determine the level of vascularization and peripheral vascular findings by fluorescence angiography in patients with aggressive retinopathy of prematurity or Type 1 retinopathy of prematurity treated with a single dose of anti-vascular endothelial growth factor.

METHODS

Data of patients referred to the authors' clinic for fluorescence angiography examination between June 2016 and September 2021 were retrospectively analyzed. Patients who had their first fluorescence angiography examination at the age of 1 year or older were included in the study.

RESULTS

A total of 486 eyes of 250 patients were included. Of these, 83 eyes (17.1%) had vascular termination in Zone II and 403 eyes (82.9%) in Zone III. In 62.7% of eyes, the distance from the vascular terminals to the temporal ora serrata was less than two disk diameters, and in 20.2%, it was more than two disk diameters. Abnormal vascular findings were noted, including circumferential vessels (41.2%), finger-like projection anomaly (36.2%), hyperfluorescence (16.9%), fine branching and blunt termination (15%), and arteriovenous shunt (9.9%).

CONCLUSION

Fluorescence angiography performed late in the course of treatment can clearly define the vascular termini and detect abnormalities that cannot be detected by indirect ophthalmoscopy. Follow-up with fluorescence angiography can help prevent complications that can lead to vision loss.

Evaluation of retinal vascularization in retinopathy of prematurity regressed after intravitreal ranibizumab monotherapy or without treatment based on fluorescein angiography

To investigate the fluorescein angiography (FA) findings and compare the extent of retinal vascularization in retinopathy of prematurity (ROP), recovered after intravitreal ranibizumab (IVR) monotherapy and those regressed spontaneously. Infants with a history of ROP who underwent FA between April 2018 and November 2021 were retrospectively included. The patients were divided into two groups based on whether they had received IVR (IVR group) or had ROP that regressed spontaneously without treatment (untreated group). The differences between the two groups in zone II ROP were also compared, to equalize the subgroups as much as possible in terms of disease severity. FA findings were recorded. The extent of vascularization was measured by the ratio of the distance from the center of the disk to the border of the vascularized zone (DB) and the distance from the center of the disk to the center of the fovea (DF). The width of the persistent avascular retina (PAR) was counted by disc diameters (DD). One hundred and ten eyes of 55 infants were included in the IVR group and 76 eyes of 38 babies in the untreated group. The ratio of abnormal shape of vessels was significantly higher in the IVR group than in the untreated group (50.9% vs. 35.5%; P = 0.038), while the linear choroidal filling pattern, tortuosity of vessels over the posterior pole, dye leakage, anomalous branching of vessels, circumferential vessels, arteriovenous shunt, abnormal capillary bed, and macular abnormalities were similarly. There was a smaller temporal DB/DF ratio (4.48 vs. 4.63; P = 0.003) and greater PAR (2.63 vs. 1.76; P < 0.001) in the IVR group compared to the untreated group. In zone II ROP, the progression of retinal vascularization was significantly larger in the IVR group than that in the untreated group (P = 0.003), while no statistical differences were observed in FA features, the DB/DF ratio, and PAR between the two subgroups. The residual vascular abnormalities and PAR may be common results of ROP regression. The DB/DF ratio of 4.0 temporally and 3.3 nasally could be used as the preliminary indicators for safe retinal vascularization in the completion of ROP regression.

Fundus fluorescein angiography imaging of retinopathy of prematurity in infants: A review

Fluorescein angiography in retinopathy of prematurity is increasingly utilized over the past decade. The development of ultra-wide-field imaging combined with fluorescein angiography has allowed improved visualization of the peripheral retinal vasculature. Patient cooperation in the pediatric population is particularly challenging, but hand-held digital retinal photography has shown promise and can visualize the infant retina without the need for anesthesia and intravenous access. Many features of retinopathy of prematurity and its response to laser and anti-VEGF treatment can be either exclusively or better visualized on fluorescein angiography compared to indirect ophthalmoscopy or color fundus photography. Disease treatment is gradually shifting from laser photocoagulation to intravitreal anti-VEGF agents, the latter being associated with late-onset vision-threatening sequelae. The role of fluorescein angiography in retinopathy of prematurity monitoring will continue to increase with the longer follow-up required and different clinical behavior seen with anti-VEGF treatment. We highlight the utility, safety, and importance of fluorescein angiography in the diagnosis, treatment, and follow-up of retinopathy of prematurity.

Refractive outcomes following unilateral laser treatment for type 1 retinopathy of prematurity

PURPOSE

To compare refractive outcomes of infants with type 1 retinopathy of prematurity (ROP) in whom one eye was treated with laser and the fellow eye spontaneously regressed.

METHODS

The medical records of infants who underwent IVB and laser treatment for type 1 ROP or aggressive posterior-ROP between January 2016 and December 2019 were retrospectively evaluated. Infants in whom ROP in the fellow eye regressed and for whom refractive data was available in the record were included in the study. Refractive outcomes of unilaterally treated infants were assessed.

RESULTS

A total of 283 cases were reviewed: of these, 17 experienced spontaneous regression in the fellow eye and were included. All unilateral laser-treated eyes had type 1 ROP in zone Ⅱ. The median age at treatment was 40 weeks' postmenstrual age (IQR, 39-41). The mean spherical equivalent at the last examination was 2.1 ± 2.5 D in treated eyes and 2.50 ± 1.4 D in nontreated eyes, at a mean age of 25.0 ± 9.1 months (P = 0.378). Of the 7 infants who underwent fluorescein angiography, the median of the ratio of the length of the temporal retinal vascularization to the optic disk-to-fovea distance was 3.71 (3.22-3.79) in treated and 4.28 (3.90-4.49) in untreated eyes, at a median age of 18 months (P = 0.018).

CONCLUSIONS

In laser-treated eyes with peripheral zone Ⅱ ROP and with advanced treatment age, we did not observe a significant myopic change compared to the fellow untreated eye.

Morphology and Vessel Density of the Macula in Preterm Children Using Optical Coherence Tomography Angiography

Background: Retinal morphology changes may be associated with prematurity and can lead to visual impairment. Optical coherence tomography angiography may contribute to understanding the pathomechanism of structural and vascular retinal impairment in premature children. The aim of this study was to assess an influence of prematurity, neonatal clinical characteristics, and a history of retinopathy of prematurity (ROP) on the morphology and retinal vascularity of macula in children. Methods: A case−control study of 123 preterm children and 86 full-term children was performed. The age of the subjects was 10.45 years (IQR: 8.12−12.77), while the age of the control group was 11.78 years (IQR: 8.81−13.79). Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA, angio-OCT) were performed using RTVueXR Avanti (Optovue, Fremont, CA, USA). Ganglion cell complex (GCC), foveal thickness (FT), parafoveal thickness (PFT), size of foveal avascular zone (FAZ) in superficial plexus, superficial capillary vessel density (sVD), deep capillary vessel density (dVD), central choroidal thickness (CCT), and presence of macular hypoplasia were analyzed. The association between OCT/angio-OCT results and clinical characteristics including the degree of ROP and therapy requirements was assessed in preterm infants. Results: Foveal morphology was affected in preterm children with high incidence of foveal hypoplasia (24.77%). GCC was thinner in preterm children compared to controls: avgGG 93 μm vs. 100 μm, p < 0.001. No associations between GCC and gestational age (R = −0.085; p = 0.228) and birth weight (R = −0.054; p = 0.446) were found. FAZ in preterm group was smaller than in controls (0.13 ± 0.09 vs. 0.22 ± 0.09; p < 0.001). FAZ area correlated with gestational age (R = 0.456; p < 0.001) and birth weight (R = 0.472; p < 0.001). Deep vessel density in the fovea was higher in preterm children than in control group (p < 0.001). PFT was significantly lower in preterm children compared to control group. However, increased thickness in the fovea was noted in preterm children (p < 0.001). FT was inversely correlated with gestational age (R = −0.562; p < 0.001) and birth weight (R = −0.508, p < 0.001). CCT was lower in preterm children (312 μm vs. 337.5 μm, p < 0.001) Parameters of GCC and FT were higher in patients with ROP required treatment compared to patients without ROP and spontaneously regressed retinopathy. FAZ was smaller in patients with retinopathy than in preterm children without ROP. Conclusion: Prematurity has a significant negative impact on GCC, macular morphology, and vascularization. In premature children, decreased FAZ, increased FT, and vessel density were strongly associated with gestational age, birth weight, Apgar score, ROP stage, and treatment requirement. Optical coherence tomography angiography is a useful tool for detecting retinal changes in premature children.