Vitreous changes after treatment of retinopathy of prematurity

Vitreous changes after intravitreal bevacizumab monotherapy for retinopathy of prematurity: a case series

Purpose

Reporting a special clinical finding after intravitreal bevacizumab monotherapy for retinopathy of prematurity.

Methods

In a retrospective case series, the clinical courses of five premature infants with similar vitreous changes after a single dose of intravitreal bevacizumab (IVB) injection without additional laser therapy were reported.

Results

The mean post-conceptional age at IVB injection was 39.8 ± 2.2 (range 37–43) weeks. Localized vitreous syneresis and linear fibrotic vitreous condensation occurred 8.2 ± 2.3 weeks after IVB monotherapy in our patients (15.5% of injections). The mean last post injection visit was 61.6 ± 5.3 weeks (post-conceptional age). Further regression and complete retinal vascularization occurred in all patients.

Conclusions

Thread-like vitreous condensation with localized vitreous liquefaction may be related to involutional ROP disease itself, combined to anti VEGF therapy and may be a predictor factor for further regression and retinal vascularization. The case series describes a successful response to anti-VEGF monotherapy with no further complications.

COMPARING THE OUTCOME OF SINGLE VERSUS MULTIPLE SESSION LASER PHOTOABLATION OF FLAT NEOVASCULARIZATION IN ZONE 1 AGGRESSIVE POSTERIOR RETINOPATHY OF PREMATURITY: A Prospective Randomized Study

PURPOSE

To compare single versus 2-session laser photoablation for flat neovascularization in cases with Zone 1 aggressive posterior retinopathy of prematurity.

METHODS

Twenty-nine Asian Indian infants with aggressive posterior retinopathy of prematurity were randomized; each eye received 1 of 2 methods (29 each in Group A or B) proposed by the PHOTO-ROP group. Group A underwent single session laser to the avascular retina underlying the flat neovascularization by direct laser over the fronds. Group B underwent laser in 2 sessions; first, laser was delivered to the avascular periphery up to the flat neovascularization and 7 days later to the avascular bed exposed by the retraction of the fronds. Outcome and complications between the two groups were compared.

RESULTS

Mean birthweight and gestational ages were 1,276 g and 30.1 weeks, respectively. All eyes showed favorable outcome at a minimum 12-month follow-up. Hemorrhages after laser (41.4% vs. 17.2%, P < 0.001) were more common in the single laser group. Large hemorrhages (>1 disk diameter) seen in Group A took longer than 8 weeks to resolve and developed focal fibrosis.

CONCLUSION

This study demonstrates that the two-staged laser procedure produces fewer and smaller hemorrhages and no fibrosis compared with a single session. Both methods have comparable favorable outcomes in Asian Indian infants.

Long term refractive and structural outcome following laser treatment for zone 1 aggressive posterior retinopathy of prematurity

AIM

To report the long term refractive, visual and structural outcome post-laser for zone 1 aggressive posterior retinopathy of prematurity (AP-ROP).

MATERIALS AND METHODS

A retrospective analysis was performed of refractive status of premature infants with zone 1 AP-ROP who underwent laser photocoagulation from 2002 to 2007 and followed up till 2013. Once the disease regressed, children were followed up six monthly with detailed examination regarding fixation pattern, ocular motility, nystagmus, detailed anterior segment and posterior segment examination, and refractive status including best corrected visual acuity.

RESULTS

Forty-eight eyes of 25 infants were included in the study. Average follow-up was 6.91 years (range, 3.8-9.5years) after laser treatment. Astigmatism was noted in 43 out of 48 eyes (89.6%). Two eyes had simple myopia whereas three eyes had no refractive error.

CONCLUSION

After successful laser treatment for zone 1 retinopathy of prematurity (ROP), 94% of our cases developed refractive error. Although most had a favorable anatomical and visual outcome, long-term follow-up even after a successful laser treatment in ROP was necessary.

Risk factors for recurrent fibrovascular proliferation in aggressive posterior retinopathy of prematurity after early vitreous surgery

PURPOSE

To analyze risk factors for postoperative recurrence of fibrovascular tissue in eyes with aggressive posterior retinopathy of prematurity (AP ROP) treated with early vitreous surgery.

DESIGN

Retrospective, consecutive, observational case series.

METHODS

Thirty-one patients (50 eyes) with AP ROP who underwent early vitreous surgery between March 2005 and April 2008 participated. Eyes with stage 4A or 4B disease in which fibrovascular tissue was not attached to the vitreous base were included; those in which fibrovascular tissue was attached extensively to vitreous base or those without dense photocoagulation to the nonvascularized retina were excluded. Eligible eyes were divided into 2 groups based on postoperative recurrence or no recurrence of fibrovascular tissue. Data on gender, gestational age, birth weight, Apgar score, intubation duration, severe systemic complications, preoperative ROP stage, zone, fibrovascular tissue and vitreous base adhesion, clock hours of fibrovascular tissue, postmenstrual age at the initial application of dense photocoagulation, dense photocoagulation to both vascularized and nonvascularized retina, postmenstrual age at vitrectomy, and intraoperative hemorrhage were collected and analyzed.

RESULTS

Fifty eyes of 31 patients underwent early vitrectomy. Seven (14%) eyes were excluded and 43 eyes (86%) were included. Eight (18%) of 43 eyes had a recurrence of fibrovascular tissue. Both univariate and multivariate analysis indicated application of dense photocoagulation to both the vascularized and nonvascularized retina was a significant factor in the decreased recurrence of fibrovascular tissue (P = .002 and P = .008, respectively).

CONCLUSIONS

Application of preoperative dense photocoagulation to vascularized and nonvascularized retina may be important for lowering the recurrence of fibrovascular tissue in eyes with AP ROP.

The risk for retinal detachment associated with hemorrhages pre- and postlaser treatment in retinopathy of prematurity

PURPOSE

To determine the risk factors including retinal or vitreous hemorrhage for retinal detachment after laser photocoagulation in threshold or aggressive posterior retinopathy of prematurity.

METHODS

The medical records of 184 eyes of 94 consecutive infants who underwent diode laser photocoagulation for threshold or aggressive posterior retinopathy of prematurity between 1996 and 2006 were retrospectively reviewed. Eight clinical variables were included in the logistic regression analysis to assess the relationship between each variable and retinal detachment of 4A or greater.

RESULTS

The mean follow-up after laser photocoagulation was 25.06 +/- 23.59 months (range: 6-85 months). Sixteen (8.7%) eyes developed a retinal detachment. Pre and posttreatment retinal or vitreous hemorrhage was present in 30 (16.3%) eyes. Among 154 eyes without hemorrhage, 6 (3.9%) developed a retinal detachment, whereas 10 of 30 (33.3%) eyes with a hemorrhage developed a retinal detachment (P < 0.001). The logistic regression analysis showed that a pretreatment hemorrhage, vitreous organization, a persistent active element of plus disease after 21 days, and posttreatment hemorrhage were statistically associated with the development of a retinal detachment.

CONCLUSION

Pre and posttreatment hemorrhage was significantly associated with the progression to retinal detachment along with vitreous organization, a persistent plus disease activity 21 days after treatment.

Late vitreous hemorrhage in patients with regressed retinopathy of prematurity

PURPOSE

To describe the characteristics of eyes with late vitreous hemorrhage in children with a history of regressed retinopathy of prematurity (ROP).

METHODS

The medical records of consecutive patients with regressed ROP presenting to our institution with late vitreous hemorrhage between 1995 and 2006 were reviewed.

RESULTS

Thirteen patients (14 eyes) were identified. All patients had stage 3 or higher ROP. Prior treatments included cryotherapy in three eyes, laser ablation in eight eyes, and laser followed by vitrectomy for retinal detachment in two eyes. Three eyes had had no prior ocular surgery. Age at late vitreous hemorrhage ranged from 10.8 months to 15 years (mean, 8.4 years). At the time of late vitreous hemorrhage, no eyes had active neovascularization, three eyes had a history of trauma, and three eyes had concurrent retinal detachment; eight eyes were observed (57%) and six (43%) were treated with vitrectomy.

CONCLUSIONS

Late vitreous hemorrhage can occur in patients with regressed ROP years after the vascularly active phase of the disease. It likely results from abnormal vitreoretinal traction on otherwise normal retinal vessels or from a normal amount of traction on residual cicatricial tissue. Vitreous hemorrhage may occur in the absence of trauma, retinal tears, retinal detachment, or active neovascularization. With appropriate management, most patients maintained their baseline vision.

Recombinant alpha2(IV)NC1 domain of type IV collagen is an effective regulator of retinal capillary endothelial cell proliferation and inhibits pre-retinal neovascularisation

BACKGROUND

A recombinant form of the alpha2(IV)NC1 domain of type IV collagen has been shown to have potent anti-angiogenic activity although this peptide has not been studied in the context of proliferative retinopathies. In the current investigation we examined the potential for alpha2(IV)NC1 to regulate retinal microvascular endothelial cell function using a range of in vitro and in vivo assay systems.

MATERIALS AND METHODS

alpha2(IV)NC1 at concentrations between 0.1 and 1 mug/ml was added to retinal microvascular endothelial cells (RMECs) followed by assessment of cell attachment, proliferation and survival. This agent was also tested within a novel in vitro three-dimensional retinal angiogenesis assay and the number of angiogenic sprouts quantified. alpha2(IV)NC1 was also delivered intra-vitreally to mice with oxygen-induced proliferative retinopathy (OIR) and neovascularisation evaluated in comparison with vehicle-treated controls.

RESULTS

RMECs treated with alpha2(IV)NC1 (0.1, 0.5 and 1 microg/ml) showed delayed attachment at 3 h post-seeding, although this deficit had been restored at the 6-h time point. BrdU assay of DNA replication revealed that confluent RMECs treated with alpha2(IV)NC1 showed no measurable response in comparison with vehicle-treated controls. By contrast, proliferation of sub-confluent RMECs was significantly reduced by alpha2(IV)NC1 at 0.5 microg/ml (P<0.01). alpha2(IV)NC1 also induced apoptosis in RMECs and inhibited angiogenesis of pre-existing retinal vascular networks in vitro (P<0.001). Intra-vitreal injection of alpha2(IV)NC1 in the OIR model significantly inhibited pre-retinal neovascularisation compared with vehicle-treated controls (P<0.001).

CONCLUSION

alpha2(IV)NC1 inhibits angiogenesis in the retinal microvasculature. This recombinant protein has potential for the treatment of neovascularisation in proliferative retinopathies.

Involution of threshold retinopathy of prematurity after diode laser photocoagulation

OBJECTIVE

To characterize the process of involution of threshold retinopathy of prematurity after transpupillary diode laser photocoagulation.

DESIGN

Retrospective case series.

PARTICIPANTS

Neonates with threshold retinopathy who underwent diode laser photocoagulation of the peripheral avascular retina.

METHODS

A retrospective chart review was done of the weekly examination records of infants treated for threshold disease. Features that were studied included the presence of residual stage 3 neovascularization, plus disease, and development of retinal detachment (RD).

MAIN OUTCOME MEASURES

Timing of full involution and/or development of an RD.

RESULTS

Of 262 eyes of 138 infants treated, full involution without RD was seen in 8%, 43%, 64%, 73%, and 86% of eyes at postoperative weeks 1, 2, 3, 4, and 9+/-3, respectively. Retinal detachments were diagnosed cumulatively in 0%, 1.5%, 4.2%, 6.5%, and 14% of eyes at weeks 1, 2, 3, 4, and 9+/-3, respectively.

CONCLUSIONS

Full involution of laser-treated threshold retinopathy of prematurity required more than 2 weeks in more than half of treated eyes. Most RDs were not detected until > or =3 weeks after treatment.