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Bilateral stage 3 zone I ROP with plus disease, intraretinal hemorrhages and extensive subhyaloid hemorrhage in the left eye.
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To report on 2 cases of aggressive posterior retinopathy of prematurity (ROP) treated with intravitreal ranibizumab (Lucentis(®)) and laser photocoagulation.
Two premature females, born at 25 and 26 weeks' gestation with a birth weight of 530 and 550 g, respectively, with aggressive posterior ROP received combined treatment with laser photocoagulat...
Context in source publication
Context 1
... first case was a female premature infant born at 25 weeks of gestation with a birth weight of 530 g. Her first screening examination was at 33 weeks of postmenstrual age, showing bilateral stage 3 zone I ROP with plus disease, intraretinal hemorrhages and extensive subhyaloid hemorrhage in the left eye ( fig. 1). There was also bilateral tunica vasculosa lentis and pupillary rigidity. Ranibizumab was injected in both eyes 72 h after observation. One week after the treatment, there was complete regression of anterior segment vessels, reduction in central vascular dilation and tortuosity and decrease of hemorrhagic collections. Laser ...Similar publications
Purpose:
To evaluate the efficacies and treatment outcomes following intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR), and laser photocoagulation (LPC) in retinopathy of prematurity (ROP).
Methods:
This was a retrospective interventional case series study including the data of 134 infants (264 eyes) who were treated with IVB, IVR,...
Citations
... There are numerous studies in the world literature which compare the efficacy of both of the above mentioned methods: monotherapy or combined treatment [21,38,39]. The studies by Hu et al. show that intravitreal injection of Ranibizumab combined with laser therapy can be effective in severe A-ROP, which is also observed in our study, where the efficacy of combined treatment for simultaneous A-ROP is 89%, and for ROP3+ even 100% [40,41]. In some severe cases with coexisting systemic conditions, including inflammatory bacterial or fungal diseases, monotherapy with only Ranibizumab may not be sufficient to treat A-ROP. ...
Background 2-year observations of ranibizumab monotherapy and combined therapy with diode laser for severe ROP in extremely prematures. Materials and methods: In a group of 18 prematures (n = 36 eyes; 5 study groups); 25.8 ± 1.5 Hbd, birth weight 796.5 ± 166.1 g. Apgar 4.62 ± 1.88) with A-ROP (n = 22; 61%) and 3 ROP (plus) (n = 14; 39%), ranibizumab monotherapy (n = 4 eyes) in dose 0.12 mg/0.12 mL or with diode laser (n = 32 eyes) were applied. The first intervention was carried out in PMA of 33 (gr. 4 and 5) and 34 in (gr. 1, 2, 3), mean follow-up time 21.44 ± 8.7 months. One-way analysis of variance (ANOVA) with Welch’s correction, non-parametric Kruskal-Wallis test, Chi square test of independence were used. A retrospective observational study based on a case series. Results Retinal attachment was achieved in 92.3% of the studied eyes. Bilateral retinal detachment was noted in 1 infant (2 eyes). Myopization (−0.75 to −7.5 D) was observed in 5 infants (45%); mild hyperopia (+0.5 to +4.5 D) was observed in the rest infants (55%). Conclusions Individualization strategies in severe ROP with lower dose 0.12 mg Ranibizumab or combined laser-therapy resulted in effective outcomes. Myopia has not been reported in patients where Ranibizumab was the first drug administered in the ROP treatment strategy.
... However, Erol [25] et al. and Wong [26] et al. used the same dose of ranibizumab to treat ROP and found high recurrence rates of ROP after treatment. Whereas In 2012, Mota [27] et al. gave 0.3 mg/0.03 ml ranibizumab for the treatment of aggressive posterior retinopathy of prematurity (APROP) and reported no ocular or systemic adverse reactions. ...
... With the goal of ensuring safety, we tried to reduce the recurrence rate of ROP by increasing the dose of ranibizumab. We found that Mota [27] et al. reported no systemic complications in patients who received 0.3 mg/0.03 ml ranibizumab for the treatment of APROP. ...
Abstract Objective To compare the recurrence rate of retinopathy of prematurity (ROP) after treatment with 0.3 mg vs. 0.25 mg ranibizumab. Subjects All patients with ROP who underwent intravitreal injection of ranibizumab in Hainan General Hospital between January 2014 and May 2020 were included in this retrospective study. Methods Eighty-two cases (146 eyes) who received intravitreal injection of 0.25 mg ranibizumab were included in the conventional-dose group, and 59 cases (108 eyes) who received intravitreal injection of 0.3 mg ranibizumab were included in the high-dose group. The two groups were further divided into the 25-28-week, 29-31-week, 32-34-week, and 35-36-week GA subgroups. The differences between the conventional-dose group and the high-dose group in gestational age (GA), birth weight (BW), age at initial injection (weeks), incidence of systemic diseases, the recurrence rate of ROP, and age at retinal vascularization completed (weeks) were analyzed. Results GA, BW, age at initial injection, and the incidence of systemic diseases were not significantly different between the conventional-dose group and the high-dose group (p > 0.05). The recurrence rates of ROP were significantly lower in the 25-28-week, 29-31-week, and 32-34-week subgroups of the high-dose group than in the same subgroups of the conventional-dose group (p
... According to computer-generated numbers, the 52 surviving rats were randomly allocated into six groups. The rats in group 1 (n = 9) were given 0.3 mg/kg/day oral dienogest [15], in group 2 (n = 9) were given 100 mg/kg/day oral danazol [15], in group 3 (n = 9) were given 30 µg/kg/day subcutaneous buserelin acetate [15], in group 4 (n = 9) were given 100 µg/kg subcutaneous zoledronic acid [16], in group 5 (n = 9) were given 0.6 mg/kg intraperitoneal ranibizumab [17] on the 1st and 14th days after the second operation, and in group 6 (n = 7) were given 1 mL/day oral 0.9% NaCl (control group). The treatment was administered continuously for 4 weeks after the operation. ...
PurposeTo investigate the histological efficacy of ranibizumab and zoledronic acid in an experimentally induced endometriosis model as compared with danazol, buserelin acetate and dienogest.Methods
Endometrial implants were introduced in 52 female Wistar albino rats, which were then randomly divided into six groups. The animals were, respectively, given dienogest, danazol, buserelin acetate, zoledronic acid, ranibizumab and 0.9% NaCl. After 4 weeks, the volumes and histopathological properties of the implants were evaluated and the implants were excised completely at the third laparotomy. A histopathological scoring system was used to evaluate the preservation of epithelia. Endometrial explants were evaluated immunohistochemically.ResultsAmong the groups, the histological score was significantly lower in the zoledronic acid and ranibizumab groups compared with the controls (p < 0.001). There were no significant differences regarding ellipsoidal volume levels between groups (p > 0.05). However, there was a statistically significant difference regarding cell numbers according to the degree of Bcl-2, NF-κB, and CD31 staining (p < 0.001). There was no statistically significant difference in Bcl-2, CD31, or NF-κB staining in the binary comparisons between the other groups (p > 0.05). For Bcl-2 staining, the staining rate of the group treated with zoledronic acid was significantly lower compared with the dienogest and danazol groups (p < 0.05). The staining rates of CD31 and NF-κB were significantly lower in the zoledronic acid and ranibizumab groups compared with the controls (p < 0.05).Conclusion
According to these results, zoledronic acid and ranibizumab may be putative candidates for the treatment of endometriosis.
... However, Erol [27] et al. and Wong [28] et al. used the same dose of ranibizumab to treat ROP and found high recurrence rates of ROP after treatment. whereas In 2012, Mota [29] et al. gave 0.3 mg/0.3 ml ranibizumab for the treatment of aggressive posterior retinopathy of prematurity (APROP) and reported no ocular or systemic adverse reactions. Therefore, since September 2017, we switched to a single injection of ranibizumab at a dose of 0.3 mg/0.3 ml per eye. ...
... With the goal of ensuring safety, we tried to reduce the recurrence rate of ROP by increasing the dose of ranibizumab. We found that Mota [29] et al. reported no systemic complications in patients who received 0.3 mg/0.3 ml ranibizumab for the treatment of APROP. Therefore, after obtaining the approval of the ethic committee of Hainan General Hospital and the consent from the patients' family members, the injection dose of ranibizumab was increased to 0.3 mg in September 2017, and that dose has been used in our hospital since then. ...
Objective: To compare the recurrence rate of retinopathy of prematurity (ROP) after treatment with 0.3 mg vs. 0.25 mg ranibizumab.
Subjects: All patients with ROP who underwent intravitreal injection of ranibizumab in Hainan General Hospital between January 2014 and May 2020 were included in this study.
Methods: 82 cases (146 eyes) who received intravitreal injection of 0.25 mg ranibizumab were included in the conventional-dose group, and 59 cases (108 eyes) who received intravitreal injection of 0.3 mg ranibizumab were included in the high-dose group. The two groups were further divided into the 25-28-week, 29-31-week, 32-34-week, and 35-36-week GA subgroups. The differences between the conventional-dose group and the high-dose group in gestational age (GA), birth weight(BW), age at initial injection(weeks), incidence of systemic diseases, the recurrence rate of ROP, and age at retinal vascularization completed(weeks) were analyzed.
Results: GA, BW, age at initial injection, and the incidence of systemic diseases were not significantly different between the conventional-dose group and the high-dose group (p>0.05). The recurrence rates of ROP were significantly lower in the 25-28-week, 29-31-week, and 32-34-week subgroups of the high-dose group than in the same subgroups of the conventional-dose group (p<0.05). Within the conventional-dose group, the recurrence rate of ROP was significantly lower in the 32-34-week and 35-36-week subgroups than in the 25-28-week and 29-31-week subgroups (p<0.05). Within the high-dose group, the recurrence rate of ROP was not significantly different between the four subgroups (p>0.05). Retinal vascularization was completed at a later age in the 32-34-week subgroup of the high-dose group than in the 32-34-week subgroup of the conventional-dose group (p<0.05) but was not significantly different between the two groups at any other GA range (p>0.05). No severe ocular or systemic complications occurred in any patient.
Conclusion: Treatment with 0.3 mg ranibizumab can reduce the recurrence rate of ROP without prolonging retinal vascularization or causing serious systemic complications. Therefore, this dose may be an appropriate therapeutic dose for ROP.
... [1,2,5,6] Current treatment modalities available for this disease include laser indirect ophthalmoscopy, vitreoretinal surgery, and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents. [6][7][8][9][10][11][12] The present study describes the role of all the current treatment modalities either alone or in combination for management of zone 1 ROP in a real-world clinical practice at a tertiary care center. ...
PURPOSE: The main purpose is to study the treatment outcomes of zone 1 retinopathy of prematurity (ROP).
MATERIALS AND METHODS: A retrospective analysis was done of infants diagnosed with zone 1 ROP with any stage with or without plus disease who were treated with either laser photocoagulation and/or intravitreal injection of antivascular endothelial growth factor (anti-VEGF) agents and/or underwent surgery according to their stage at presentation. The retinal outcome at the final visit was analyzed. A favorable outcome was characterized by an attached retina at the posterior pole with regression of ROP (regression of plus disease as well as new vessels) while an unfavorable outcome was detached retina at posterior pole in spite of treatment.
RESULTS: Seventy-eight eyes of 39 infants presented with zone 1 ROP in various stages with plus disease in 50% cases. About 60 eyes underwent treatment. Forty eyes (66.6%) had an attached retina at the final follow-up. Thirty-three eyes (55%) underwent monotherapy with 14 eyes (23.3%) showing regression of ROP with laser alone. Nineteen (31.6%) eyes were treated only by surgery. Of these, a favorable outcome was seen in four eyes (44.4%) with Stage 4 disease and three eyes (30%) with Stage 5 disease. None of the eyes received anti-VEGF as monotherapy. A combination of two or more modalities was required in the remaining 27 eyes (45%). Six eyes (10%) needed anti-VEGF injections in addition to laser and six eyes needed surgery in addition to laser to achieve a favorable outcome. Six eyes (10%) required surgery in addition to both laser and anti-VEGF therapy, and one eye (1.6%) required surgery in addition to anti-VEGF therapy for a favorable final outcome. Among the eyes undergoing treatment, 66.6% had a favorable outcome with 92.9% of eyes in Stage 3, 59% in Stage 4, and 33% in Stage 5 showing regression of disease and attached retina.
CONCLUSION: In spite of the aggressive nature of zone 1 ROP, favorable outcome is possible as was seen in 66.6% of our cases. A multipronged approach using a combination of laser, intravitreal anti-VEGF agents with or without surgery may be necessary for the management of these eyes.
... . Because of the role of VEGF in ROP, there is a growing body of evidence supporting the use of targeted pharmacologic inhibition of VEGF in the management of ROP (Sonmez et al 2008, Sato et al 2009). There are a number of reports of favorable experience with the off-label use of intravitreal bevacizumab or ranibizumab in the management of ROP (Chung et al 2007, Travassos et al 2007, Honda et al 2008, Kusaka et al 2008, Lalwani et al 2008, Mintz-Hittner and Kuffel Jr 2008, Quiroz-Mercado et al 2008, Ahmed et al 2010, Altinsoy et al 2010, Dorta and Kychenthal 2010, Law et al 2010, Lee et al 2010, Nazari et al 2010, Zepeda-Romero et al 2010, Harder et al 2011, Mintz-Hittner et al 2011, Wu et al 2011, Lin et al 2012,Mota et al 2012, Castellanos et al 2013, Kim et al 2014. Most reports used approximately 50% of the adult intravitreal dose per eye, although efficacy has also been reported with lower doses(Harder et al 2011, Kim et al 2014. ...
Background:
Despite increasing worldwide use of anti-vascular endothelial growth factor agents for treatment of retinopathy of prematurity (ROP), there are few data on their ocular efficacy, the appropriate drug and dose, the need for retreatment, and the possibility of long-term systemic effects. We evaluated the efficacy and safety of intravitreal ranibizumab compared with laser therapy in treatment of ROP.
Methods:
This randomised, open-label, superiority multicentre, three-arm, parallel group trial was done in 87 neonatal and ophthalmic centres in 26 countries. We screened infants with birthweight less than 1500 g who met criteria for treatment for retinopathy, and randomised patients equally (1:1:1) to receive a single bilateral intravitreal dose of ranibizumab 0·2 mg or ranibizumab 0·1 mg, or laser therapy. Individuals were stratified by disease zone and geographical region using computer interactive response technology. The primary outcome was survival with no active retinopathy, no unfavourable structural outcomes, or need for a different treatment modality at or before 24 weeks (two-sided α=0·05 for superiority of ranibizumab 0·2 mg against laser therapy). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02375971.
Interpretation:
Between Dec 31, 2015, and June 29, 2017, 225 participants (ranibizumab 0·2 mg n=74, ranibizumab 0·1 mg n=77, laser therapy n=74) were randomly assigned. Seven were withdrawn before treatment (n=1, n=1, n=5, respectively) and 17 did not complete follow-up to 24 weeks, including four deaths in each group. 214 infants were assessed for the primary outcome (n=70, n=76, n=68, respectively). Treatment success occurred in 56 (80%) of 70 infants receiving ranibizumab 0·2 mg compared with 57 (75%) of 76 infants receiving ranibizumab 0·1 mg and 45 (66%) of 68 infants after laser therapy. Using a hierarchical testing strategy, compared with laser therapy the odds ratio (OR) of treatment success following ranibizumab 0·2 mg was 2·19 (95% Cl 0·99-4·82, p=0·051), and following ranibizumab 0·1 mg was 1·57 (95% Cl 0·76-3·26); for ranibizumab 0·2 mg compared with 0·1 mg the OR was 1·35 (95% Cl 0·61-2·98). One infant had an unfavourable structural outcome following ranibizumab 0·2 mg, compared with five following ranibizumab 0·1 mg and seven after laser therapy. Death, serious and non-serious systemic adverse events, and ocular adverse events were evenly distributed between the three groups.
Findings:
In the treatment of ROP, ranibizumab 0·2 mg might be superior to laser therapy, with fewer unfavourable ocular outcomes than laser therapy and with an acceptable 24-week safety profile.
Funding:
Novartis.
... Treatment with anti-VEGF followed by laser treatment (4-5 days later) in these cases has improved the efficacy of laser along with a reduced need for extensive laser, especially in zone I ROP. [22] Using a new lightweight, portable, handy, and inexpensive (costing only Rs. 19,999 or $380) smartphone-based fundus camera (MII Ret Cam) [9] attached with +20 D lens, we were able to capture high-quality fundus videos and images in preterm infants, documenting type 1 ROP and improvement after laser treatment [ Fig. 1]. Although this smartphone-based fundus camera has only approximately 30° field of view, we were able to capture both central and peripheral retinal images, which can be used only for clinical documentation and better understanding for the treating ophthalmologist and neonatologist and counseling parents, especially in case of type 1 ROP. ...
Purpose:
The purpose was to study the incidence, risk factors, and anatomical outcomes after laser treatment in retinopathy of prematurity (ROP).
Methods:
A retrospective observational study was carried out. Infants admitted to Neonatal Intensive Care Unit of 12 referral hospitals between April 2016 and September 2017 were screened according to the latest Indian guidelines based on the International Classification of Retinopathy of Prematurity.
Results:
The incidence of ROP in 1648 eyes screened was 25.36% (418 eyes), out of which high-risk prethreshold ROP (type 1) was observed in 9.95% (164 eyes). Decreased hemoglobin (P < 0.001), oxygen requirement (P = 0.008), and number of blood transfusions (P = 0.037) were significant with type 1 than type 2 (low-risk prethreshold) ROP. Stages 1, 2, and 3 were observed in 82 (32.28%), 154 (60.62%), and 18 (7.08%) eyes, respectively. Aggressive posterior ROP (APROP) was observed in 20.73% eyes with type 1 ROP. Ten eyes showing APROP were treated at an early gestational age of 29 weeks. All infants with type 1 ROP were treated with laser photocoagulation only.
Conclusion:
One-fourth of the infants showed ROP and one-tenth needed laser photocoagulation, the outcome of which was excellent. Risk factors predisposing to ROP were anemia, high oxygen supplementation, increased number of blood transfusions, and septicemia. ROP screening in infants ≥1700 g birth weight associated with various systemic risk factors may be beneficial in the Indian population.
... V případě hraničního nálezu mezi oběma typy je indikace a rozhodnutí o způsobu léčby na oftalmologovi. [1,2,10,11,14,18,20,21,24,25,27,[31][32][33]38,41,44,47,50]. Ukazuje se, že léčba anti-VEGF preparáty umožňuje přiměřený vývoj vaskularizace sítnice a je spojena s nižším výskytem refrakčních vad a lepší výslednou zrakovou ostrostí. ...
... Retinal laser photocoagulation is a standard treatment for ROP. However, it can result in many problems, such as a wide range of retinal damage and the loss of vision in the photocoagulation area, and is not suitable for some patients, such as those with ROP in zone 1 or AP-ROP [44][45][46]. Anti-VEGF drugs may reduce complications when treating ROP. At the same time, anti-VEGF drugs can maintain the balance of VEGF and promote the continued development of retinal blood vessels in children with ROP [7,[40][41][42]. ...
Background:
Retinopathy of prematurity (ROP) is a vascular proliferative disorder of the developing retina and a significant cause of childhood blindness around the world. The incidence of ROP is affected by many factors, and the incidence rate varies from country to country. The purpose of this study is to report the incidence and risk factors of ROP in neonatal intensive care unit (NICU) of Guangzhou First People's Hospital in China.
Methods:
A retrospective review was performed on 436 premature infants who were consecutive ROP screened in the NICU of Guangzhou First People's Hospital from March 2013 to October 2017. The single-factor analysis and the logistic multivariate regression analysis were used to detect risk factors of ROP.
Results:
Total 436 premature infants were consecutive ROP screened, 138 (31.65%) were found ROP, and 61(13.99%) were treated. The single-factor analysis revealed that the incidence of ROP was associated with multiple births, gestational age, birth weight, mechanical ventilation, intravascular hemolysis, the number of operations and blood culture results. The logistic multivariate regression analysis revealed that gestational age; birth weight, mechanical ventilation, minimum SaO2 and daily weight gain were independent risk factors for ROP onset. Forty-nine patients underwent retinal laser photocoagulation with recurrence 20 patients. Twelve patients underwent anti-VEGF drug (Ranibizumab) via intraocular injection with 5 patients of recurrence.
Conclusions:
The incidence of ROP in NICU of Guangzhou China will match those in middle-income countries, but higher than high-income countries. Anti-VEGF drugs could be preferred as a good treatment method for zone 1 ROP and aggressive posterior ROP.
... treatment 8 , injections of anti-VEGF without laser ablation 2,9 , a combination of these therapies applied simultaneously 10 , combined therapies in which laser ablation is complemented by anti-VEGF injection in the case of laser failure 11,12 , and combined therapies in which laser ablation is used in the case of injection failure 13 . ...
... The obtained functional results are difficult to compare with the studies of other authors. Kim 10 , in a group of 18 eyes treated with simultaneous anti-VEGF injection and laser therapy, and Mota et al. 12 in a paper describing two cases treated with combination therapy evaluated only anatomical outcomes. Araz-Ersan et al. 11 analysed anatomical outcomes and neurodevelopmental disabilities in 13 patients treated with simultaneous laser photocoagulation and bevacizumab injection. ...
The purpose of this study was to investigate the anatomical and functional outcomes of the two-stage treatment of severe retinopathy of prematurity (ROP) using laser photocoagulation and intravitreal ranibizumab injection. The medical records of 53 eyes of 28 infants treated by conventional laser photocoagulation with deferred intravitreal 0.25 mg/0.025 mL ranibizumab injection were analysed. All patients had at least 11 months of follow-up. In the analysed group, the mean gestational age at birth was 25 weeks and mean birthweight was 790 g. The mean time of laser photocoagulation was 34 weeks of postmenstrual age (PMA). Ranibizumab injection was performed on average at 37 weeks of PMA. The mean time between interventions was 19 days. Retinal detachment occurred in 12 eyes (22.6%), in three children bilaterally. Visual responses were obtained in 23 of 28 treated children. Our results indicate that ranibizumab injection can be taken into consideration in the selected cases of laser photocoagulation failure. The unsatisfactory results of this study elicited a change in the ROP treatment protocol in our medical centre. The study gives an insight into anatomical and functional outcomes of ROP treatment in the Central and Eastern European population.
