Reactivation of Retinopathy of Prematurity After Bevacizumab Injection

Figure 1. Case 3. A, RetCam (Clarity Medical Systems Inc) 80° color fundus photograph of the right eye immediately after the start of laser treatment demonstrating posterior recurrence (indicated with *) of extraretinal fibrovascular proliferation. The extraretinal vessels are an irregular vascular proliferation not accompanied by opaque or translucent fibrous elements seen in classic retinopathy of prematurity ridge stage 2 or extraretinal fibrovascular proliferation stage 3 nor are they the usual frond or brush border pattern seen in aggressive posterior retinopathy of prematurity. B, RetCam color fundus photograph of the left eye prior to laser treatment demonstrating posterior recurrence (indicated with *) more prominent than anterior recurrence (indicated with arrows). The posterior extraretinal vessels are fine vessels unaccompanied by high-contrast opaque tissue. C, Montage RetCam color fundus photograph of the left eye after anterior laser treatment demonstrating posterior recurrence (indicated with *) of extraretinal fibrovascular proliferation. Laser treatment posterior to the anterior ridge (not visualized in the photograph) was initiated but not completed at the time of the photograph. Dilated vessels helped to direct the examiner's attention posteriorly to the extraretinal vasculature, which is largely devoid of fibrosis.

Figure 2. Case 5. A, RetCam (Clarity Medical Systems Inc) color fundus photograph of the right eye demonstrating posterior contracted extraretinal fibrovascular proliferation (black arrow) as well as anterior extraretinal fibrovascular proliferation (white arrow). Laser treatment was applied posterior to the second ridge because of presumed posterior incomplete vascularization in this area. B, Montage RetCam color fundus photograph of the left eye demonstrating posterior extraretinal fibrovascular proliferation (black arrow) as well as anterior extraretinal fibrovascular proliferation (white arrow).

Figure 3. Case 8. A, RetCam (Clarity Medical Systems Inc) color fundus photograph of the right eye demonstrates total retinal detachment (stage 5 retinopathy of prematurity). B, RetCam color fundus photograph of the left eye with scleral depression of the anterior retina shows stage 4a retinopathy of prematurity with a temporal band of fibrous elements at the apex of the detachment. C, Temporal dragging of the vessels of the retina by the tractional elements seen in part B resulted in a narrowed angle between the temporal arcade vessels, residual inferior venous dilation and tortuosity, and a heterotopic macula in the left eye.

Figure 4. Case 9. A, Montage RetCam (Clarity Medical Systems Inc) color fundus photograph of the right eye demonstrates the posterior pole without evidence of extraretinal fibrovascular proliferation. No extraretinal vessels are seen emanating from the posterior arcade (white arrow). The black arrow indicates an anomalous circumferential vessel for correlation with part B. B, Montage RetCam fluorescein angiography of the right eye demonstrating leakage of posterior pole vasculature. The mechanism for leakage may be that (1) intrinsic retinal vasculature leaks abnormally, (2) there may be fine extraretinal vessels or vascular channel remnants that leak, or (3) tractional forces, presumably from regressed extraretinal fibrovascular proliferation, cause leakage. The white arrow corresponds to the area indicated by the white arrow in part A. The black arrow indicates an anomalous circumferential vessel, corresponding to part A. C, Montage RetCam red-free fundus photograph of the left eye demonstrating retinal vasculature without evidence of extraretinal fibrovascular proliferation. Arrows correlate to the location of arrows in part D. D, Montage RetCam fluorescein angiography of the left eye demonstrating leakage of posterior pole vasculature. Arrows correspond to the location of arrows in part C.