Efficacy of Primary Intravitreal Ranibizumab Injection for Treatment of Type 1 Retinopathy of Prematurity

Gyu Chul Chung; Sung-Hyuk Moon

doi:10.3341/jkos.2017.58.9.1080

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Chung and Moon: Efficacy of Primary Intravitreal Ranibizumab Injection for Treatment of Type 1 Retinopathy of Prematurity

Original Article

J Korean Ophthalmol Soc 2017;58(9):1080-1086.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.9.1080

Efficacy of Primary Intravitreal Ranibizumab Injection for Treatment of Type 1 Retinopathy of Prematurity

Gyu Chul Chung, M.D.^1,², Sung-Hyuk Moon, MD, PhD^1,²

¹Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

²T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

Address reprint requests to Sung-Hyuk Moon, MD, PhD Department of Ophthalmology, Inje University Busan Paik Hospital, #75 Bokji-ro, Busanjin-gu, Busan 47392, Korea Tel: 82-51-890-6016, Fax: 82-51-890-6329 E-mail: koils79@naver.com

This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare Affairs, Republic of Korea (grant #: HI15C1142).

* Conflicts of Interest: The authors have no conflicts to disclose.

Received 29 June 20171 August 2017 Accepted 23 August 2017

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 effectiveness and safety of primary intravitreal ranibizumab injection as a treatment for retinopathy of prematurity.

Methods

Retrospective analysis of the medical records of patients diagnosed with retinopathy of prematurity and treated with in-travitreal ranibizumab injection from January 1, 2013 to January 1, 2016 was performed. We complied with the standards for ‘prethresold, type 1’ established by the Early Treatment of Retinopathy of Prematurity study for intravitreal ranibizumab injection. The follow-up period after injection was at least 9 months. Patients who received additional treatment such as laser photo-coagulation or intravitreal injection without reactivation of retinopathy of prematurity were excluded.

Results

A total of 21 patients (39 eyes) were included in this study. Nine (16 eyes) were male and 12 (23 eyes) were female. The average duration between treatment decision and intravitreal ranibizumab injection was 2.1 ± 1.5 days. Complete regression of the plus sign occurred 18.2 ± 9.1days after injection. One eye with reactivation was treated with panretinal laser photocoagulation while four other eyes with reactivation were treated with intravitreal bevacizumab injection. There were 87.1% (34/39) eyes that underwent primary intravitreal ranibizumab injection with stable results without any reactivation. There were no systemic compli-cations related to intravitreal ranibizumab injection.

Conclusions

Primary intravitreal ranibizumab injection as a treatment for retinopathy of prematurity showed good efficacy and safety. However, thorough evaluation is needed after primary intravitreal ranibizumab injection due to the potential for reactivation. Long-term monitoring is needed after intravitreal ranibizumab injection.

Keywords: Intravitreal injection, Ranibizumab, Retinopathy of prematurity, Type 1

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Table 1.

Characteristics of subject patients

Factors	Results (mean ± SD, median)
Sex (male:female)	9:12
Gestational age	25 + 5 weeks (±8 days), 26 + 0 weeks
Birth weight (g)	775.2 ± 189.7, 720
NSVD:C-sec	5:16
PCA at first treatment	37 + 5 weeks (±17 days), 36 + 4 weeks
Days between treatment decision date and intravitreal injection date (days)	2.1 ± 1.5, 2
Beginning of plus regression after the injection (days)	3.3 ± 2.1, 3
Complete regression of plus after the injection (days)	17.6 ± 8.6, 15
Follow up period after the injection (months)	17.4 ± 7.9, 17
ROP stages at first treatment (eyes, %)
Zone I, stage 3, plus+	4 (10.3)
Zone II, stage 2, plus+	6 (15.4)
Zone II, stage 3, plus+	29 (74.4)

Values are presented as mean ± SD unless otherwise indicated.

SD = standard deviations; NVSD = normal spontaneous vaginal delivery; C-sec = cesarean section; PCA = postconceptional age; ROP = retinopathy of prematurity.

Table 2.

Characteristics of eyes treated with intravitreal ranibizumab injection

Case	Sex	GA	Birth weight (g)	Zone/Stage/Plus (OD)	Zone/Stage/Plus (OS)	PCA at first treatment	Beginning of plus regression (OD, days)	Beginning of plus regression (OS, days)	Complete regression of plus (OD, days)	Complete regression of plus (OS, days)	F/U period (months)	Retreatment	Other comorbidities
1	M	26 + 4	860	^*	II post 3 +	37 + 1	^*	4	^*	19	33	No	RDS, BPD
2	F	27 + 3	810	II post 3 +	II post 3 +	38	3	3	15	15	29	No	RDS, NEC, PDA
3	M	24 + 3	720	II post 3 +	II post 3 +	36 + 1	5	5	26	26	29	No	RDS. PDA
4	F	24 + 6	705	II post 2 +	II post 2 +	35	5	4	28	28	21	No	RDS, PDA
5	F	27	920	I post 3 +	I post 3 +	34 + 4	3	3	32	32	22	No	RDS, BPD, PDA, thrombocytopenia
6	F	26 + 4	915	II post 2 +	II post 2 +	35 + 4	3	3	12	12	27	No	RDS. BPD, PDA
7	M	28 + 4	1,400	II post 3 +	^*	36 + 3	3	^*	10	^*	22	No	RDS
8	F	25	495	I post 3 +	I post 3 +	40 + 2	2	2	14	14	21	No	RDS, BPD, PDA, NEC, short bowel syndrome
9	M	25+2	840	II post 3 +	II post 3 +	41 + 3	8	8	33	33	21	No	RDS, BPD, PDA, hydrocephalus
10	F	24 + 2	579	II post 3 +	II post 3 +	35 + 5	7	6	18	18	22	No	RDS. PDA, pneumothorax
11	M	24 + 5	790	II post 3 +	II post 3 +	36 + 4	6	6	21	21	17	No	RDS, PDA
12	F	24 + 6	820	II post 2 +	II post 2 +	39 + 5	2	2	11	t	10	Yes (OS)	RDS, NEC, fecal impaction, post hemorrhagic hydrocephalus
13	M	24	640	II post 3 +	II post 3 +	35 + 1	6	6	30	30	11	No	RDS, BPD, PDA, hypothyroidism
14	F	27 + 1	845	II post 3 +	II post 3 +	42 + 2	3	3	22	22	9	No	RDS, PDA, hydrocephalus
15	M	25 + 4	720	II post 3 +	^*	35 + 6	4	^*	12	^*	9	No	RDS, PDA, inguinal hernia
16	M	26 + 6	660	II post 3 +	II post 3 +	39 + 6	1	1	15	15	9	No	RDS
17	F	26	640	II post 3 +	II post 3 +	36 + 4	1	1	7	7	12	Yes (OU)	RDS, BPD, NEC
18	F	26	660	II post 3 +	II post 3 +	36 + 4	1	1	7	7	12	Yes (OU)	RDS, BPD, PDA
19	M	26 + 6	980	II post 3 +	II post 3 +	42 + 6	1	1	14	14	9	No	RDS, BPD, PDA
20	F	26 + 4	640	II post 3 +	II post 3 +	37	1	1	7	7	10	No	RDS, BPD, PDA
21	F	24 + 4	640	II post 3 +	II post 3 +	37	1	1	7	7	10	No	RDS, BPD, PDA

GA = gestational age (weeks + days); OD = oculus dexter; OS = oculus sinister; PCA = postconceptional age; F/U = follow-up; M = male; F = female; OU = oculus unitas; RDS = respiratory distress syndrome; BPD = bronchopulmonary dysplasia; NEC = necrotizing enterocolitis; PDA = patent ductus arteriosus.

^* Missing value is due to the unmet criteria of prethreshold, type I, retinopathy of prematurity (ROP); Missing value indicates that there was no complete regression of plus sign after the primary intravitreal ranibizumab injection.

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