Fibrovascular contraction and tractional retinal detachment (TRD) are recognized complications associated with the use of anti–vascular endothelial growth factor agents in vasoproliferative vitreoretinopathies. The authors characterize TRDs that developed after intravitreal bevacizumab or ranibizumab therapy for vascularly active retinopathy of prematurity.
This is an international, multicenter, interventional, retrospective, case series. Thirty-five eyes from 23 infants were included. Inclusion required anti–vascular endothelial growth factor treatment of Type 1 retinopathy of prematurity with progression to TRD.
Mean gestational age was 26 ± 2 weeks, and mean birth weight was 873 ± 341 g. Mean postmenstrual age on the day of injection was 35 ± 2 weeks. Retinal detachment was noted a mean of 70 days (median, 34; range, 4–335) after injection. Eleven percent detached within 1 week, 23% within 2 weeks, and 49% within 4 weeks. The highest stage of retinopathy of prematurity noted was 4A in 29%, 4B in 37%, and 5 in 34% of eyes. Time to RD negatively correlated with postmenstrual age at the time of injection (Rho = −0.54; P < 0.01). Three TRD configurations were observed: 1) conventional peripheral elevated ridge or volcano-shaped Stage 5 detachment, 2) midperipheral detachment with tight circumferential vectors, and 3) very posterior detachment with prepapillary contraction. Full or partial reattachment was achieved with surgical intervention in 86% of eyes.
Progressive atypical TRD may occur after anti–vascular endothelial growth factor injections for retinopathy of prematurity. The configuration of the detachment varies with the extent of primary retinal vascularization present at the time of treatment.
The authors present a series of infants who developed progressive retinal detachment after treatment with anti-VEGF agents for retinopathy of prematurity.
*Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts;
†Pediatric Retina Surgery Service, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts;
‡Department of Ophthalmology, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan;
§Department of Ophthalmology, National Institute for Mother and Child Health Alessandrescu-Rusescu, Bucharest, Romania;
¶Retina Service, Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago, Illinois;
**Associated Retinal Consultants, Royal Oak, Michigan;
††Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
‡‡Florida Retina Institute, Jacksonville, Florida.
Reprint requests: Antonio Capone, Jr., MD, Associated Retinal Consultants, William Beaumont Hospital, 3555 West Thirteen Mile Road, Suite LL-20, Royal Oak, MI 48073; e-mail: firstname.lastname@example.org
The following are general grants, and the funding organizations played no role in the design or conduct of the study, collection, management, analysis, and interpretation of the data, preparation, review, or approval of the manuscript. Unrestricted grants from Research to Prevent Blindness, to the Illinois Eye and Ear Infirmary, University of Illinois (R.V.P.C.). Grants from the Ministry of Science and Technology, Taipei, Taiwan (NSC101-2314-B-182A-055-MY3; MOST104-2314-B-182A-100-MY2) and Chang Gung Memorial Hospital, Taoyuan, Taiwan (CMRPG3D0251; CMRPG3D0522) (W.C.W.).
Paper presented in part at the American Society of Retina Specialists Annual Meeting, Vienna, Austria, July 13, 2015; the Retina Society Annual Meeting, Paris, France, October 10, 2015.
Founders and equity owners of FocusROP and Retinal Solutions (K.A.D., M.T.T., A.C.). The remaining authors have no conflicting interests to disclose.