Effect of Primary Intravitreal Bevacizumab Injection on Stage 3 Retinopathy of Prematurity with Plus Signs

Sung Eun Kim; Tyler Hyung Taek Rim; Christopher Seungkyu Lee

doi:10.3341/jkos.2015.56.1.62

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Kim, Rim, and Lee: Effect of Primary Intravitreal Bevacizumab Injection on Stage 3 Retinopathy of Prematurity with Plus Signs

Original Article

J Korean Ophthalmol Soc 2015;56(1):62-69.

Published online: 6 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.1.62

Effect of Primary Intravitreal Bevacizumab Injection on Stage 3 Retinopathy of Prematurity with Plus Signs

Sung Eun Kim, MD, Tyler Hyung Taek Rim, MD, Christopher Seungkyu Lee, MD

Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

Address reprint requests to Christopher Seungkyu Lee, MD, Department of Ophthalmology, Severance Hospital, #50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea, Tel: 82-2-2228-3570, Fax: 82-2-312-0541 E-mail: sklee219@yuhs.ac

Received 31 May 201411 July 2014 Accepted 2 December 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the efficacy and safety of primary intravitreal bevacizumab injection in stage 3 retinopathy of prematurity with plus signs.

Methods

We reviewed retrospectively the medical records of 30 eyes of 16 patients diagnosed with stage 3 retinopathy of pre-maturity with plus signs treated with primary intravitreal bevacizumab injection between March 1, 2011 and February 28, 2013 and followed up for at least 9 months.

Results

Mean gestational age was 26 + 4 weeks ± 11 days and mean birth weight was 822 ± 251.4 g. The locations of disease were zone II in 24 eyes and zone III in 6 eyes. Intravitreal bevacizumab injection was performed after the mean 1.3 ± 1 day after plus signs were detected. Mean postconceptional age at treatment was 38 + 2 weeks ± 16 days. Mean follow-up period was 16.6 ± 6.9 months. Plus signs started to regress after the mean 4.6 ± 2.3 days after injection and completely regressed after the mean 24.3 ± 12.4 days. Cataract extraction was performed in 1 eye due to a cataract that appeared not associated with the injection procedure, but was regarded as a treatment failure. There were no local or systemic complications.

Conclusions

Primary intravitreal bevacizumab injection in stage 3 retinopathy of prematurity with plus signs demonstrated ex-cellent short-term efficacy and safety.

Keywords: Avastin, Bevacizumab, Retinopathy of prematurity

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Figure 1.

Case 15. Fundus photographs taken just before operation (A, B, C) and one month after intravitreal bevacizumab injection (D, E, F). (A, B, C) Zone II, stage III retinopathy of prematurity with plus signs. (D, E, F) Regressed plus signs with decreased vascular tortuousness and disappeared retinal neovascularization and hemorrhage are noted. Further vascularization in zone II is also noted.

Table 1.

Characteristics of study population (30 eyes of 16 patients)

Factors	Mean ± SD
Sex (M:F)	1:0.78
NSVD:C-sec	1:2.2
Gestational age	26 + 4 weeks (±11 days)
BWT	822 g (±251.4)
Zone II/III (eye)	24/6
PCA at onset of plus (A)	38 + 1 weeks (±16 days)
PCA at first treatment (B)	38 + 2 weeks (±16 days)
(B) - (A)	1.3 days (±1)
Beginning of regression of plus	4.6 days (±2.3) after injection
Complete regression of plus	24.3 days (±12.4) after injection
Follow-up peroid	16.6 months (±6.9)
Other comordidities among 16 patients
PDA	15
HMD	16
GMH	7
BPD	16

NSVD = normal spontaneous vaginal delivery; C-sec = cesarean section; BWT = birth weight; PCA = postconceptional age; PDA = patent ductus arteriosus; HMD = hyaline membrane disease; GMH = germinal matrix hemorrhage; BPD = bronchopulmonary dysplasia.

Table 2.

Characteristics of individual eye treated with primary intravitreal bevacizumab injection for stage 3 + retinopathy of pre-maturity

Case	e Sex	Type of delivery	Gestational age (weeks)	Birth weight (g)	Eye	Zone	PCA at onset of plus (weeks)	PCA at first treatment (weeks)	Times to beginning of regression of plus (days)	Times to complete regression of plus (days)	Follow-up period (months)	Anatomical outcome at last visit	Retreat- ment
1	F	C-sec	25 + 6	770	OS	II	35 + 2	35 + 2	4	18	22	F	N
2	M	C-sec	29 + 3	1,035	OD	II	37 + 5	37 + 6	3	54	28	F	Y
					OS	II			3	54		F	Y
3	F	C-sec	26	595	OD	II	36 + 6	37	3	22	29	F	N
					OS	II			3	22		F	N
4	F	C-sec	28 + 3	440	OD	II	38 + 5	39 + 1	3	8	24	F	N
					OS	II			3	8		UF	N
5	M	C-sec	26	930	OD	II	38 + 3	38 + 4	3	8	23	F	N
					OS	II			3	8		F	N
6	F	C-sec	24 + 4	585	OD	II	37	37 + 2	8	19	15	F	N
					OS	II			8	19		F	N
7	F	C-sec	27 + 4	645	OD	II	37 + 5	38	5	33	12	F	N
					OS	II			5	33		F	N
8	F	C-sec	25 + 5	660	OD	II	40 + 2	40 + 4	5	12	21	F	N
					OS	II			5	12		F	N
9	M	NSVD	26 + 1	845	OD	III	41 + 1	41 + 2	4	27	10	F	N
					OS	III			4	27		F	N
10	M	C-sec	29	1,210	OD	III	38 + 4	38 + 6	3	32	10	F	N
					OS	III			3	32		F	N
11	M	NSVD	26 + 2	860	OD	II	34 + 3	34 + 3	8	36	14	F	N
					OS	II			8	36		F	N
12	F	NSVD	26 + 2	850	OD	II	35 + 4	35 + 4	2	35	10	F	N
					OS	II			2	35		F	N
13	M	NSVD	25 + 5	855	OD	II	40 + 5	41	2	16	9	F	N
					OS	II			2	16		F	N
14	M	NSVD	24 + 1	620	OD	II	37 + 6	38 + 2	9	30	16	F	N
					OS	II			9	30		F	N
15	M	C-sec	25 + 2	800	OS	II	34 + 2	34 + 2	3	19	15	F	N
16	M	C-sec	28 + 5	1,415	OD	III	42 + 4	42 + 4	7	14	9	F	N
					OS	III			7	14		F	N

NSVD = normal spontaneous vaginal delivery; C-sec = cesarean section; PCA = postconceptional age; F = favorable; UF = unfavorable.

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