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  • Late recurrence common after anti-VEGF for ROP

    Pediatric Ophth/Strabismus

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    This retrospective study found ROP recurrence after initial bevacizumab treatment is common and occurs later than with primary laser treatment.

    The authors described their experience with 17 eyes (nine patients) with ROP, all of which progressed despite initial treatment with bevacizumab monotherapy (Avastin). All eyes underwent additional treatment with bevacizumab (four eyes), laser photocoagulation (12 eyes), or surgical retinal detachment repair (five eyes).

    Mean age at treatment-requiring recurrence was 49.3 weeks postmenstrual age (PMA) (minimum, 37 weeks; maximum, 69 weeks). The mean time between initial treatment and treatment-requiring recurrence was 14.4 weeks, with a minimum of four and maximum of 35 weeks.

    Fives eyes progressed to retinal detachment. The age at retinal detachment was a mean of 58.4 weeks PMA and ranged from 49 to 69 weeks PMA. None of the five eyes that received laser treatment for recurrence progressed to detachment.

    They note that 47 percent of eyes had anterior recurrence only, 12 percent had posterior recurrence only, and 41 percent had combined anterior and posterior recurrence patterns. The authors write that this posterior recurrence pattern has not been well-described previously and may interfere with diagnosis. Posterior extraretinal vessels may grow with minimal or no fibrous elements and may show little color contrast or may be mistaken as hemorrhages, making them difficult to identify. Furthermore, broader vitreoretinal adhesions between both anterior and posterior ridges, as well as altered adhesion strength at the vitreoretinal interface, may lead to higher contractile force and more rapidly developing retinal detachment.

    They conclude that given the long interval to recurrence in this study, as well as that in the BEAT-ROP study, follow-up for patients with ROP receiving bevacizumab monotherapy should be prolonged and highly vigilant. They consider the definitive endpoint for ROP treated by bevacizumab monotherapy an unsettled issue and say more studies are needed to determine the optimal pattern of anti-VEGF therapy.