This article was corrected | View correction
To report late reactivation and progression of retinopathy of prematurity (ROP) after intravitreal bevacizumab monotherapy.
Retrospective review of 9 patients (17 eyes) with recurrence of ROP after initial treatment with intravitreal bevacizumab monotherapy. Data collected included (1) location and stage of ROP activity, (2) number and timing of treatments, and (3) structural outcomes.
Mean age at treatment-requiring recurrence was 49.3 weeks (SD, 9.1 weeks; minimum, 37 weeks; maximum, 69 weeks) postmenstrual age (PMA). The mean time between initial treatment and treatment-requiring recurrence was 14.4 weeks, with a minimum of 4 and maximum of 35 weeks. Fives eyes progressed to retinal detachment (4 eyes stage 5, 1 eye stage 4a). Age at retinal detachment ranged from 49 to 69 weeks PMA with a median of 55 weeks PMA and mean of 58.4 weeks PMA. No eye that received laser treatment for recurrence progressed to retinal detachment.
Although intravitreal bevacizumab treatment is effective in inducing regression of ROP, the effect may be transient. Recurrence can occur later in the course than with conventional laser therapy. Late retinal detachment can occur despite early regression. Long-term favorable structural outcome may require extended observation and retreatment. Laser may be a useful treatment for recurrences.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
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.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and
Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early
dhildhood mortality and growth failure data and their association with maternal
Thank you for submitting a comment on this article. It will be reviewed by JAMA Ophthalmology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 2
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.