ROP treated with ranibizumab or low-dose bevacizumab may need re-treatment

This study examined retinopathy of prematurity (ROP) re-treatment rates following initial ROP treatment with anti-VEGF therapy (ranibizumab or bevacizumab) at various doses.

Study design

This was a US-based, multicenter retrospective consecutive case series of 567 eyes that required re-treatment after initial treatment with anti-VEGF intravitreal injections for ROP. Data were collected over a 15-year period.

Outcomes

Initial treatment with ranibizumab was associated with a higher re-treatment rate than initial treatment with bevacizumab (58% vs 37%, respectively). Among patients initially treated with bevacizumab, the re-treatment rate was lower in those who received a higher dose originally; however, the same effect was not observed in patients initially given ranibizumab.

Limitations

The re-treatment rates for bevacizumab (all doses) were high in this study compared with those seen in prior reports. Also, the intention behind the laser re-treatments reported in this study (e.g., to treat true reactivation or prophylaxis of persistent avascular retina) is difficult to determine retrospectively.

Clinical significance

These study results alert ophthalmologists caring for neonates with ROP to be particularly vigilant for reactivation in patients treated initially with ranibizumab or low-dose bevacizumab. This is particularly important given the evidence that very low-dose bevacizumab is effective, as well as concerns regarding systemic absorption.

Financial Disclosures: Dr. Jagger Koerner discloses no financial relationships.