Outcomes and prognostic factors for aggressive posterior retinopathy of prematurity following initial treatment with intravitreal ranibizumab

Abstract

Background: This study sought to identify factors associated with retinal detachment and retreatment of aggressive posterior retinopathy of prematurity (APROP) initially treated with intravitreal ranibizumab (IVR) injection as well as the efficacy of IVR treatment.

Methods: This was a retrospective study. A total of 83 preterm infants (160 eyes) diagnosed with APROP who were primarily treated with IVR were included. The 160 eyes were divided into two groups based on the anatomic outcomes. Group A included 35 eyes that developed retinal detachment, and Group B included 125 eyes without retinal detachment. The following patient factors were retrospectively reviewed: gender, gestational age (GA), birth weight (BW), postmenstrual age (PMA) at first treatment, iris neovascularizations, retinal hemorrhage, neutrophil and lymphocyte counts before the first intravitreal injection, neutrophil-to-lymphocyte ratio (NLR), anatomical outcomes, additional treatment and follow-up time. Three dummy variables were created as dependent variables based on the methods of retreatment. The possible risk factors for APROP were evaluated, and statistical analyses included univariate and multivariate logistic regression.

Results: A total of 160 eyes from 83 preterm infants (56 males and 27 females) underwent initial IVR treatment with a follow-up time of 17.17 ± 10.54 months. Thirty-five of the 160 (21.9%) eyes progressed to retinal detachment, and 82 of the 125 (65.6%) non-retinal detachment eyes needed retreatment, with favorable anatomical outcomes. The disease improved approximately 1.5 ± 1.2 weeks after the first IVR treatment. The mean recurrence period of APROP was approximately 7.5 ± 6.9 weeks after the first IVR treatment. Multiple logistic regression analysis revealed postmenstrual age (P < 0.001) and neutrophil count (P = 0.009) as the most significant factors for retinal detachment in APROP. Retinal hemorrhage (P = 0.007) and BW (P = 0.04) were most significantly associated with APROP recurrence and retreatment.

Conclusions: IVR injection is an effective treatment for APROP. In this study, older postmenstrual age and low neutrophil count were identified as risk factors for retinal detachment in APROP. In addition, retinal hemorrhage and low BW were significantly associated with recurrence and retreatment in non-retinal detachment APROP. Thus, patients with a lower BW, older postmenstrual age, low neutrophil count and retinal hemorrhage should be reexamined in a timely and more frequent manner.

Keywords: Aggressive posterior retinopathy of prematurity; Birthweight; Intravitreal injection; Neutrophil count; Postmenstrual age; Ranibizumab; Recurrence; Retinal detachment; Retinal hemorrhage.

Fig. 1

Fundus photographs of a patient in the retinal detachment group. a An eye of an infant with aggressive posterior retinopathy of prematurity (APROP) before intravitreal ranibizumab (IVR) treatment. The iris neovascularizations were observed clearly. b A fundus photograph of the same eye before IVR in which retinal hemorrhage and thick preretinal hemorrhage can be seen. c The iris neovascularizations regressed after two weeks of IVR. d Fibrosis is seen in the fundus after two weeks of IVR. e No iris neovascularizations were observed after 25 days of IVR. f Then, 25 days after the first IVR, tractional retinal detachment occurred

Fig. 2

The receiver operating characteristic (ROC) curve for the risk factors postmenstrual age and neutrophil count at the first treatment. The area under the curve is 0.843 (95% CI: 0.770–0.916, P < 0.001)

Fig. 3

Photographs of a patient in the retreatment group before and after IVR treatment. a The anterior segment image of the right eye of an infant with aggressive posterior retinopathy of prematurity (APROP) before intravitreal ranibizumab (IVR) treatment showing iris neovascularizations around the pupil (white arrowhead). b A fundus photograph of the same eye before IVR. c Six weeks after the first IVR, the iris neovascularizations regressed completely. d Six weeks after the first IVR, the plus disease and ridge regressed. e The plus disease reoccurred, and vitreous retinal hemorrhage was observed after 12 weeks of the first IVR. The infant underwent a second IVR. f Four weeks after the second IVR, the plus disease regressed. g Thirteen months after the first IVR treatment. h Three years after the first IVR treatment