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Letter
A new, theoretically safer method of intravitreal injection of bevacizumab in progressive retinopathy of prematurity using scleral trans-illumination
  1. C K Patel,
  2. N J Walker,
  3. J K Kam
  1. Oxford Eye Hospital, Oxford, UK
  1. Correspondence to Dr Chetan K Patel, Oxford Eye Hospital, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK; ckpatel{at}btinternet.com

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Elevated levels of vascular endothelial growth factor (VEGF) drive retinopathy of prematurity (ROP).1 Laser photocoagulation of avascular retina reduces the risk of severe visual loss, presumably by decreasing VEGF production, but causes loss of peripheral retinal function.2 There has, therefore, been considerable interest in potential application of anti-VEGF agents such as bevacizumab as primary treatment or adjunct to photocoagulation.3 4 However, injections are associated with complications. Anatomical site and vector of injection strongly influence potential for some complications—too posterior risks retinal breaks while too anterior may damage the lens. Despite this, there is no consensus regarding injection site in neonatal patients, with investigators variously administering 0.5–2.0 mm posterior to limbus (table 1).

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Table 1

Variations in intravitreal injection procedure between various investigators

Ocular trans-illumination studies in adults show two dark bands with an intervening light band—the anterior dark band corresponding …

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