Clinical Management of Recurrent Retinopathy of Prematurity after Intravitreal Bevacizumab Monotherapy.
Clinical Management of Recurrent Retinopathy of Prematurity after Intravitreal Bevacizumab Monotherapy.
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DOI：
10.1016/j.ophtha.2016.04.028
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发表时间：
2016-09
期刊：
影响因子：
13.7
通讯作者：
Chuang AZ
中科院分区：
文献类型：
--
作者：
Mintz-Hittner HA;Geloneck MM;Chuang AZ
确定玻璃体内贝伐珠单抗（IVB）单药治疗复发性早产儿视网膜病变（ROP）的（1）发病率、（2）风险因素、（3）风险期和（4）特征。回顾性病例系列。在后I区或后II区发生1型ROP [细分为ROP 3+期和侵袭性后ROP（APROP）]的早产儿，接受IVB单药治疗，并随访至少65周校正年龄（AA）。对IVB单药治疗后发生1型ROP复发的婴儿进行回顾性审查，包括RetCam眼底照片和荧光素血管造影检查。复发性ROP的发生率、危险因素、危险期和特征。回顾了241例（471眼）婴儿IVB单药治疗的情况。(1)婴儿复发率为8.3%（20/241），眼复发率为7.2%（34/471）。(2)最显著的复发风险因素是新生血管的出现，如APROP（P=0.006），住院时间延长（P=0.01），出生体重较低（P=0.024）。(3)复发风险期为AA ≥ 45 - 55周[婴儿为90.0%（18/20），眼睛为94.1%（32/34）]，平均复发为AA 51.2周（±4.6;范围45.7 - 64.9），治疗之间的平均间隔为16.2周（±4.4）。(4)复发特征包括疾病，（20/20名婴儿; 100%）和在以下部位出现的新血管形成：（i）ROP 3+期，融合性新血管形成在前进边缘和初始脊和视网膜外纤维血管增生复合体处复发（12/14名婴儿; 85.7%）。然而，（ii）APROP（6/6例婴儿; 100%）[和ROP 3+期伴非融合性新生血管形成（2/14例婴儿; 14.3%）]仅在前缘复发。此外，视网膜血管化的前部程度降低（平均1.76与4.48椎间盘直径[DD]），视网膜血管化的速度延迟（平均0.11与0.23 DD/周），分别在那些有与没有复发。IVB再治疗后，加上疾病持续存在，新生血管消退，视网膜血管化进展最小且缓慢。患有严重ROP的早产儿正在用IVB单药治疗成功。然而，复发并不罕见，因此有必要进行警惕的随访，以确保在需要时及时重新治疗。了解复发发生率、风险因素、风险期和特征，可以进行量身定制的临床管理。
To determine (1) incidence, (2) risk factors, (3) risk period, and (4) characteristics of recurrent retinopathy of prematurity (ROP) treated by intravitreal bevacizumab (IVB) monotherapy. Retrospective case series. Premature infants developing Type 1 ROP [subdivided into ROP stage 3+ and aggressive posterior ROP (APROP)] in zone I or zone II posterior, receiving IVB monotherapy, and followed for at least 65 weeks adjusted age (AA). Retrospective review of infants who developed recurrence of Type 1 ROP following IVB monotherapy was performed including examination of RetCam fundus photographs and fluorescein angiograms. Incidence, risk factors, risk period, and characteristics of recurrent ROP. IVB monotherapy in 241 infants (471 eyes) was reviewed. (1) Recurrence incidence was 8.3% (20/241) for infants and 7.2% (34/471) for eyes. (2) Recurrence risk factors of greatest significance were appearance of neovascularization as APROP (P=0.006), extended duration of hospitalization (P=0.01), and lower birth weight (P=0.024). (3) Recurrence risk period was between ≈45 and ≈55 weeks AA [90.0% (18/20) for infants and 94.1% (32/34) for eyes] with mean recurrence of 51.2 weeks AA (±4.6; range 45.7 to 64.9), and mean interval of 16.2 weeks (±4.4) between treatments. (4) Recurrence characteristics included plus disease, (20/20 infants; 100%) and neovascularization appeared at the following sites: (i) ROP stage 3+ with confluent neovascularization recurred both at the advancing edge and at the initial ridge and extra-retinal fibrovascular proliferative complex (12/14 infants; 85.7%). However, (ii) APROP (6/6 infants; 100%) [and ROP stage 3+ with non-confluent neovascularization (2/14 infants; 14.3%)] recurred only at the advancing edge. Also, the anterior extent of retinal vascularization was decreased (mean 1.76 versus 4.48 disc diameters [DD]), and the rate of retinal vascularization was delayed (mean 0.11 versus 0.23 DD/week) in those with versus without recurrence, respectively. Following retreatment with IVB, plus disease persisted, neovascularization regressed, and retinal vascularization proceeded minimally and slowly. Premature children developing severe ROP are being treated successfully with IVB monotherapy. However, recurrence is not uncommon, so vigilant follow-up is necessary to ensure timely re-treatment when needed. Knowledge of recurrence incidence, risk factors, risk period, and characteristics allows tailored clinical management.