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Ultra-low-dose intravitreal bevacizumab for the treatment of retinopathy of prematurity: a case series
  1. Roxane J Hillier1,2,
  2. Alan J Connor1,
  3. Ayad E Shafiq1
  1. 1Department of Ophthalmology, Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  2. 2Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Roxane J Hillier, Consultant Ophthalmologist & Vitreoretinal Surgeon, Newcastle Eye Centre, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK; roxanehillier{at}gmail.com

Abstract

Background Intravitreal bevacizumab (IVB) has emerged as an effective treatment modality for the management of retinopathy of prematurity (ROP) where the disease is severe and posterior. Despite evidence of systemic vascular endothelial growth factor suppression and concerns about how this might affect the developing neonate, the optimal dose is unknown to date. We report our experience of using ultra-low-dose (0.16 mg) IVB, one-quarter of the ‘standard’ dose that has widely been reported in the treatment of ROP.

Methods A retrospective observational case series of consecutive infants who underwent ultra-low-dose IVB injection for the management of ROP at a regional neonatal intensive care unit in the North East of England, between November 2013 and August 2016.

Results 29 eyes of 15 infants underwent IVB injection. We defined ‘treatment success’ as complete regression of retinopathy and vascularisation into (or laser ablation of) zone 3. Primary success (in response to IVB 0.16 mg alone) was observed in 23/29 eyes (79.3%). Secondary success (where additional treatment was required) was observed in 27/29 eyes (93.1%). One infant died of respiratory disease during follow-up. Retreatment occurred in 6/29 eyes (20.6%). Retreatments occurred at a mean of 9.8 weeks after initial IVB (range 6–15) and at a mean of 44 weeks postmenstrual age (range 40–50).

Conclusion 0.16 mg IVB is effective in the treatment of severe and posterior ROP, with no adverse ocular outcomes occurring in our series.

  • Bevacizumab

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Footnotes

  • Contributors All authors (RJH, AJC, AES) made substantial contributions to the conception of the work, or the acquisition, analysis or interpretation of data for the work, drafting the work or revising it critically for important intellectual content, final approval of the version to be published, and are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Patient consent The patients are not identifiable.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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