Fluorescein angiographic observations of peripheral retinal vessel growth in infants after intravitreal injection of bevacizumab as sole therapy for zone I and posterior zone II retinopathy of prematurity

Abstract

Aim: To evaluate vascularisation of the peripheral retina using fluorescein angiography (FA) digital recordings of infants who had been treated with intravitreal bevacizumab (IVB) as sole therapy for zone I and posterior zone II retinopathy of prematurity (ROP).

Methods: A retrospective evaluation was performed of medical records, RetCam fundus images and RetCam fluorescein angiogram videos of 10 neonates (20 eyes) who received intravitreal bevacizumab injections as the only treatment for zone I and posterior zone II ROP between August 2007 and November 2012.

Results: All eyes had initial resolution of posterior disease after IVB injection as documented by RetCam colour fundus photographs. Using a distance of 2 disc diameters from the ora serrata to vascular termini as the upper limit of allowable avascular retina in children, the FA of these infants demonstrated that 11 of 20 eyes had not achieved normal retinal vascularisation.

Conclusions: Although bevacizumab appears effective in bringing resolution of zone I and posterior zone II ROP and allowing growth of peripheral retinal vessels, in our series of 20 eyes, complete normal peripheral retinal vascularisation was not achieved in half of the patients.

Keywords: Embryology and Development; Imaging; Neovascularisation; Retina.

Figure 1

Case no. 5: aggressive posterior retinopathy of prematurity. Posterior fundus before intravitreal bevacizumab injection (IVB) (A,B); after injection of IVB (C,D); fluorescein angiography 46 weeks after IVB, demonstrates less than 2 disc diameters (DD) of avascular retina (E,F).

Figure 2

Case no. 10: aggressive posterior retinopathy of prematurity. Posterior fundus before intravitreal bevacizumab injection (IVB) (A,B); resolution of posterior disease after IVB (C,D). The peripheral retina remains avascular with fluorescein leakage more than 4 years after IVB (E,F).

Figure 3

Case no. 8: posterior retinopathy of prematurity. Posterior fundus before intravitreal bevacizumab injection (IVB) (A,B); avascular peripheral retina without leakage 21 weeks after IVB (C,D); avascular peripheral retina with fluorescein leakage in both eyes 89 weeks after IVB (E,F).

Figure 4

Case no. 7: posterior retinopathy of prematurity, the twin sister of case no. 8. Posterior fundus before intravitreal bevacizumab injection (IVB) (A,B); avascular peripheral retina without fluorescein leakage in both eyes 18 weeks after IVB (C,D); fully vascularised peripheral retina in the left eye, and avascular retina with fluorescein leakage in the right eye 86 weeks after IVB (E,F).