• Neuro-Ophthalmology/Orbit

    This case study illustrates that intravitreal bevacizumab may be associated with late and atypical retinopathy of prematurity (ROP) recurrence despite adjuvant early laser treatment.

    The patient, who was born at 25 weeks’ gestation with a birth weight of 490 g, received bilateral intravitreal bevacizumab injections for type 1 ROP at 36 weeks’ postmenstrual age. He underwent laser photocoagulation in both eyes five days later, confluent except for one clock hour obscured by hemorrhage in the left eye.

    Despite initial regression, neovascularization in both vascularized and lasered retina with plus disease recurred, requiring repeat laser bilaterally at 51 weeks' postmenstrual age and vitrectomy in the left eye at 54 weeks' postmenstrual age.

    The authors note that even though late recurrence is thought to occur rarely after laser treatment, infants who have received both bevacizumab injections and laser may still require long-term surveillance for recurrence. In this case, fundus photography proved valuable for demonstrating recurrent plus disease even though the initial treatments had resulted in marked retinal vessel attenuation.

    They note that while the appearance of the retinal vessels at 51 weeks’ postmenstrual age did not meet traditional criteria for plus disease, comparison of serial fundus photographs clearly showed a dramatic increase in vessel caliber and tortuosity. They say that optic nerve ischemia and marked vessel attenuation can mask recurrent plus disease unless close attention is paid to relative changes in vessel appearance.

    They add that in the left eye, the presence of one clock hour not treated with the laser, may have contributed to a worse recurrence and the need for vitrectomy.

    They say that the mechanism of late recurrence following intravitreal bevacizumab remains unclear. One hypothesis is that normal-appearing vascularized retina may remain abnormally perfused and a potential continued source of vascular endothelial growth factor.