Vitrectomy after intravitreal bevacizumab (Avastin) for retinal detachment in retinopathy of prematurity

Abstract

Purpose: The purpose of this study was to evaluate the feasibility of performing vitrectomies after using bevacizumab (Avastin, Genentech, South San Francisco, CA) for the management of retinal detachments in retinopathy of prematurity.

Methods: Eleven eyes of 8 children with retinopathy of prematurity retinal detachment that developed despite peripheral ablation with indirect diode laser were injected with 0.625 mg bevacizumab. Injections were given through the pars plicata, and the status of the central retinal artery was checked with indirect ophthalmoscopy. A vitreoretinal surgery was scheduled for 1 week after the bevacizumab injection. All eyes underwent surgery using 25- or 23-gauge instrumentation. Demographic data, neovascular activity, and the anatomic status of the retina were evaluated. Systemic and local perioperative complications were recorded.

Results: The average gestational birth weight was 950 g, and the average gestational age at birth was 25.7 weeks. Although 9 eyes had stage 4A, 2 had stage 4B retinal detachments. Six eyes had zone II and five eyes had zone I disease. Bevacizumab was injected at an average postgestational age of 38 weeks. A notable reduction in the vascular activity could be observed 1 week later when vitrectomy was performed. With a mean follow-up of 8.5 months (range, 2-13 months), a favorable outcome could be observed in all eyes. Only one eye with persistent vitreous hemorrhage required reoperation. No complications attributable to the bevacizumab injections were noted.

Conclusion: These data show that vitrectomy after intravitreal bevacizumab can be effective in selected cases. The regression of the vascular activity induced by this drug might contribute to better results in some of these cases. There were no apparent short-term safety concerns for intravitreal bevacizumab injections in these babies. However, additional studies are needed to define the role of bevacizumab as a possible adjuvant in the management of retinopathy of prematurity retinal detachments.