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H Narnaware S, K Bawankule P, Raje D. Aggressive Posterior Retinopathy of Prematurity (APROP): LASER as the Primary Modality of Treatment. JOVR [Internet]. 2021Jul.29 [cited 2024May8];16(3):400–407. Available from: https://knepublishing.com/index.php/JOVR/article/view/9437
https://doi.org/10.18502/jovr.v16i3.9437
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authors
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Shilpi H Narnaware
Shilpi H Narnaware
Consultant Vitreo-retina & ROP Specialist, Sarakshi Netralaya, Rajiv Nagar, Wardha Road, Nagpur 440025, Maharashtra, India
-
Prashant K Bawankule
Prashant K Bawankule
Vitreo-Retinal Surgeon, Rajiv Nagar, Wardha Road, Nagpur 440025 Maharashtra, India
-
Dhananjay Raje
Dhananjay Raje
Head, Data Analysis Group, MDS Bio-analytics Pvt. Ltd., Shankar Nagar, Nagpur 440010, Maharashtra, India
Published Date
- Jul 29, 2021
Aggressive Posterior Retinopathy of Prematurity (APROP): LASER as the Primary Modality of Treatment
Abstract
Purpose: To study the success rate of LASER as a primary modality of treatment in aggressive posterior retinopathy of prematurity (APROP) cases.
Methods: This is a prospective case series of 56 eyes of 28 preterm babies (males = 21) with APROP who underwent laser therapy. Babies were divided into groups on the basis of gestational age (GA), birth weight (BW), and postmenstrual age (PMA) at which treatment was performed. GA (in weeks): <28 (n = 7), 28–30 (n = 11), >30 (n = 10). BW (in grams): <1000 (n = 8), 1000–1200 (n = 10), >1200 (n = 10). PMA (in weeks): < 32 (n = 6), 32–34 (n = 18), >34 (n = 4). Success was calculated as complete regression of disease without need for any other modality of treatment such as anti-vascular endothelial growth factor (anti-VEGF) or pars plana vitrectomy.
Results: The overall success rate was 94.64% (53/56). Two babies who needed additional modality of treatment were <28 weeks of GA (one eye) and 28–30 weeks (two eyes). One baby (one eye) was <1000 gm and the other (two eyes) was >1200 gm, while PMA at which additional treatment was needed was 30 weeks in one baby (one eye) and 33 weeks in the other (two eyes).
Conclusion: In this era of anti-VEGF treatment, even in cases of APROP, LASER should still be considered as a primary modality of treatment, as it is a one-time treatment without the concern of systemic side effects and recurrent/persistent avascular zones.
Keywords:
Aggressive Posterior Retinopathy of Prematurity, LASERS, Success Ra
References
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9. Mintz-Hittner HA, Kennedy KA, Chuang AZ, BEAT-ROP Cooperative Group. Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity. N Engl J Med 2011;364:603–615.
10. Gunay M, Celik G, Gunay BO, Aktas A, Karatekin G, Ovali F, et al. Evaluation of 2-year outcomes following intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity. Arq Bras Oftalmol 2015;78:300–304.
11. Nicoară SD, Ştefănuţ AC, Nascutzy C, Zaharie GC, Toader LE, Drugan TC, et al. Regression rates following the treatment of aggressive posterior retinopathy of prematurity with bevacizumab versus laser: 8-year retrospective analysis. Med Sci Monit 2016;22:1192–1209.
12. International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005;123:991–999.
13. Gunn DJ, Cartwright DW, Gole GA. Prevalence and outcomes of laser treatment of aggressive posterior retinopathy of prematurity. Clin Exp Ophthalmol 2014;42:459–465.
14. Ahn YJ, Hong KE, Yum HR, Lee JH, Kim KS, Youn YA, et al. Characteristic clinical features associated with aggressive posterior retinopathy of prematurity. Eye 2017;31:924–930.
15. Tong Q, Yin H, Zhao M, Li X, Yu W. Outcomes and prognostic factors for aggressive posterior retinopathy of prematurity following initial treatment with intravitreal ranibizumab. BMC Ophthalmol 2018;18:150.
16. Lorenz B, Stieger K, Jäger M, Mais C, Stieger S, Andrassi- Darida M, et al. Retinal vascular development with 0.312 mg intravitreal bevacizumab to treat severe posterior retinopathy of prematurity: a longitudinal fluorescein angiographic study. Retina 2017;37:97–111.
17. Mintz-Hittner HA, Geloneck MM, Chuang AZ. Clinical management of recurrent retinopathy of prematurity after intravitreal bevacizumab monotherapy. Ophthalmology 2016;123:1845–1855.
18. Blair M, Garcia Gonzalez JM, Snyder L, Schechet S, Greenwald M, Shapiro M, et al. Bevacizumab or laser for aggressive posterior retinopathy of prematurity. Taiwan J Ophthalmol 2018;8;243–248.
19. Hu J, Blair MP, Shapiro MJ, Lichtenstein SJ, Galasso JM, Kapur R. Reactivation of retinopathy of prematurity after bevacizumab injection. Arch Ophthalmol 2012;130:1000– 1006.
20. Nicoară SD, Ştefănuţ AC, Nascutzy FC, Zaharie GC, Toader LE, Drugan TC. Regression rates following the treatment of aggressive posterior retinopathy of prematurity with bevacizumab versus laser: 8-year retrospective analysis. Med Sci Monit 2016;22:1192–1209.
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22. Yonekawa Y, Wu W-C, Nitulescu CE, Paul Chan RV, Thanos A, Thomas BJ, et al. Progressive retinal detachment in infants with retinopathy of prematurity treated with intravitreal bevacizumab or ranibizumab. Retina 2018;38:1079–1083.
23. Carneiro AM, Costa R, Falcão MS, Barthelmes D, Mendonça LS, Fonseca SL, et al. Vascular endothelial growth factor plasma levels before and after treatment of neovascular age-related macular degeneration with bevacizumab or ranibizumab. Acta Ophthalmol 2012;90:e25–e30.
24. Wang D, Choi CS, Lee SJ. Serum concentration of vascular endothelial growth factor after bilateral intravitreal injection of bevacizumab. Korean J Ophthalmol 2014;28:32–38.
25. Sato T, Wada K, Arahori H, Kuno N, Imoto K, Iwahashi- Shima C, et al. Serum concentrations of bevacizumab (Avastin) and vascular endothelial growth factor in infants with retinopathy of prematurity. Am J Ophthalmol 2012;153:327–333.
26. Wu W-C, Lien R, Liao P-J, Wang N-K, Chen Y-P, A Chao, et al. Serum levels of vascular endothelial growth factor and related factors after intravitreous bevacizumab injection for retinopathy of prematurity. JAMA Ophthalmol 2015;133;391–397.
27. Hong YR, Kim YH, Kim SY, Nam GY, Cheon HJ, Lee SJ. Plasma concentrations of vascular endothelial growth factor in retinopathy of prematurity after intravitreal bevacizumab injection. Retina 2015;35:1772–1777.
28. Yang CH. Anti-vascular endothelium growth factor therapy for retinopathy of prematurity: a continuing debate. Taiwan J Ophthalmol 2012;2:115–116.
29. Martínez-Castellanos MA, Schwartz S, Hernández-Rojas ML, Kon-Jara VA, García-Aguirre G, Guerrero-Naranjo JL, et al. Long-term effect of anti-angiogenic therapy for retinopathy of prematurity up to 5 years of follow up. Retina 2013;33:329–338.
30. Morin J, Mai Luu T, Superstein R, Ospina LH, Lefebvre F, Simard M-N, et al. Neurodevelopmental outcomes following bevacizumab injections for retinopathy of prematurity. Pediatrics 2016;137:4.
31. Wu LH, Yang YH, Lin CH, Lin YJ, Cheng CL. Hypotension associated with intravitreal bevacizumab therapy for retinopathy of prematurity. Pediatrics 2016;137:e20152005.
32. Fernandez MP, Berrocal AM, Goff TC, Ghassibi MP, Armitage Harper C, Chou E, et al. Histopathologic characterization of the expression of vascular endothelial growth factor in a case of retinopathy of prematurity treated with ranibizumab. Am J Ophthalmol 2017;176:134–140.
33. Moran S, O’Keefe M, Hartnett C, Lanigan B, Murphy J, Donoghue V. Bevacizumab versus diode laser in stage 3 posterior retinopathy of prematurity. Acta Ophthalmol 2014;92:e496–e497.
34. Araz-Ersan B, Kir N, Tuncer S, Aydinoglu-Candan O, Yildiz-Inec D, Akdogan B, et al. Preliminary anatomical and neurodevelopmental outcomes of intravitreal bevacizumab as adjunctive treatment for retinopath of prematurity. Curr Eye Res 2014;15:1–7.
35. Hartnett ME, Penn JS. Mechanisms and management of retinopathy of prematurity. N Engl J Med 2012;367:2515– 2526.
36. Quinn GE, Dobson V, Hardy RJ, Tung B, Palmer EA, Good WV, et al. Visual field extent at 6 years of age in children who had high-risk prethreshold retinopathy of prematurity. Arch Ophthalmol 2011;129:127–132.
37. O’Connor AR, Wilson CM, Fielder AR. Ophthalmological problems associated with preterm birth. Eye 2007;21:1254–1260.
38. Larsson E, Rydberg A, Holmstrom G. Contrast sensitivity in 10 year old preterm and full term children: a population based study. Br J Ophthalmol 2006;90:87–90.
39. Dobson V, Quinn GE, Abramov I, Hardy RJ, Tung B, Siatkowski RM, et al. Color vision measured with pseudoisochromatic plates at five-and-a-half years in eyes of children from the CRYO-ROP study. Invest Ophthalmol Vis Sci 1996;37:2467–2474.
40. Hwang CK, Hubbard GB, Hutchinson AK, Lambert SR. Outcomes after intravitreal bevacizumab versus laser photocoagulation for retinopathy of prematurity: a 5-year retrospective analysis. Ophthalmology 2015;122:1008– 1015.
41. Geloneck MM, Chuang AZ, Clark WL, Hunt MG, Norman AA, Packwood EA, et al. Refractive outcomes following bevacizumab monotherapy compared with conventional laser treatment: a randomized clinical trial. JAMA Ophthalmol 2014;132:1327–1333.
42. Kuo HK, Sun IT, Chung MY, Chen YH. Refractive error in patients with retinopathy of prematurity after laser photocoagulation or bevacizumab monotherapy. Ophthalmologica 2015;234:211–217.
43. Gunay M, Celik G, Gunay BO, Aktas A, Karatekin G, Ovali F. Evaluation of 2-year outcomes following intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity. Arq Bras Oftalmol 2015;78:300–304.
44. Isaac M, Mireskandari K, Tehrani N. Treatment of type 1 retinopathy of prematurity with bevacizumab versus laser. J AAPOS 2015;19:140–144.
45. Tan Q-Q, Christiansen SP, Wang J. Development of refractive error in children treated for retinopathy of prematurity with anti-vascular endothelial growth factor (anti-VEGF) agents: a meta-analysis and systematic review. PLoS One 2019;14:12.
2. Charan R, Dogra MR, Gupta A, Narang A. The incidence of retinopathy of prematurity in a neonatal care unit. Ind J Ophthalmol 1995;43:123–126.
3. Varughese S, Jain S, Gupta N, Singh S, Tyagi V, Puliyel JM. Magnitude of the problem of retinopathy of prematurity. Experience in a large maternity unit with a medium size level-3 nursery. Ind J Ophthalmol 2001;49:187–188.
4. Hungi B, Vinekar A, Datti N, Kariyappa P, Braganza S, Chinnaiah S, et al. Retinopathy of prematurity in a rural neonatal intensive care unit in South India-a prospective study. Ind J Ped 2012;79:911–915.
5. Nicoară SD, Nascutzy C, Cristian C, Irimescu I, Ștefănuț AC, Zaharie G, et al. Outcomes and prognostic factors of intravitreal bevacizumab monotherapy in zone I stage 3+ and aggressive posterior retinopathy of prematurity. J Ophthalmol 2015;2015:102582.
6. Sanghi G, Dogra MR, Katoch D, Gupta A. Aggressive posterior retinopathy of prematurity: risk factors for retinal detachment despite confluent laser photocoagulation. Am J Ophthalmol 2013;155:159–164.e2.
7. Drenser KA, Trese MT, Capone A Jr. Aggressive posterior retinopathy of prematurity. Retina 2010;30:S37–S40.
8. Pandya HK, Faia LJ, Robinson J, Drenser KA. Macular development in aggressive posterior retinopathy of prematurity. Biomed Res Int 2015;2015:808639.
9. Mintz-Hittner HA, Kennedy KA, Chuang AZ, BEAT-ROP Cooperative Group. Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity. N Engl J Med 2011;364:603–615.
10. Gunay M, Celik G, Gunay BO, Aktas A, Karatekin G, Ovali F, et al. Evaluation of 2-year outcomes following intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity. Arq Bras Oftalmol 2015;78:300–304.
11. Nicoară SD, Ştefănuţ AC, Nascutzy C, Zaharie GC, Toader LE, Drugan TC, et al. Regression rates following the treatment of aggressive posterior retinopathy of prematurity with bevacizumab versus laser: 8-year retrospective analysis. Med Sci Monit 2016;22:1192–1209.
12. International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005;123:991–999.
13. Gunn DJ, Cartwright DW, Gole GA. Prevalence and outcomes of laser treatment of aggressive posterior retinopathy of prematurity. Clin Exp Ophthalmol 2014;42:459–465.
14. Ahn YJ, Hong KE, Yum HR, Lee JH, Kim KS, Youn YA, et al. Characteristic clinical features associated with aggressive posterior retinopathy of prematurity. Eye 2017;31:924–930.
15. Tong Q, Yin H, Zhao M, Li X, Yu W. Outcomes and prognostic factors for aggressive posterior retinopathy of prematurity following initial treatment with intravitreal ranibizumab. BMC Ophthalmol 2018;18:150.
16. Lorenz B, Stieger K, Jäger M, Mais C, Stieger S, Andrassi- Darida M, et al. Retinal vascular development with 0.312 mg intravitreal bevacizumab to treat severe posterior retinopathy of prematurity: a longitudinal fluorescein angiographic study. Retina 2017;37:97–111.
17. Mintz-Hittner HA, Geloneck MM, Chuang AZ. Clinical management of recurrent retinopathy of prematurity after intravitreal bevacizumab monotherapy. Ophthalmology 2016;123:1845–1855.
18. Blair M, Garcia Gonzalez JM, Snyder L, Schechet S, Greenwald M, Shapiro M, et al. Bevacizumab or laser for aggressive posterior retinopathy of prematurity. Taiwan J Ophthalmol 2018;8;243–248.
19. Hu J, Blair MP, Shapiro MJ, Lichtenstein SJ, Galasso JM, Kapur R. Reactivation of retinopathy of prematurity after bevacizumab injection. Arch Ophthalmol 2012;130:1000– 1006.
20. Nicoară SD, Ştefănuţ AC, Nascutzy FC, Zaharie GC, Toader LE, Drugan TC. Regression rates following the treatment of aggressive posterior retinopathy of prematurity with bevacizumab versus laser: 8-year retrospective analysis. Med Sci Monit 2016;22:1192–1209.
21. Lepore D, Quinn GE, Molle F, Baldascino A, Orazi L, Sammartino M, et al. Intravitreal bevacizumab versus laser treatment in type 1 retinopathy of prematurity: report on fluorescein angiographic findings. Ophthalmology 2014;121:2212–2219.
22. Yonekawa Y, Wu W-C, Nitulescu CE, Paul Chan RV, Thanos A, Thomas BJ, et al. Progressive retinal detachment in infants with retinopathy of prematurity treated with intravitreal bevacizumab or ranibizumab. Retina 2018;38:1079–1083.
23. Carneiro AM, Costa R, Falcão MS, Barthelmes D, Mendonça LS, Fonseca SL, et al. Vascular endothelial growth factor plasma levels before and after treatment of neovascular age-related macular degeneration with bevacizumab or ranibizumab. Acta Ophthalmol 2012;90:e25–e30.
24. Wang D, Choi CS, Lee SJ. Serum concentration of vascular endothelial growth factor after bilateral intravitreal injection of bevacizumab. Korean J Ophthalmol 2014;28:32–38.
25. Sato T, Wada K, Arahori H, Kuno N, Imoto K, Iwahashi- Shima C, et al. Serum concentrations of bevacizumab (Avastin) and vascular endothelial growth factor in infants with retinopathy of prematurity. Am J Ophthalmol 2012;153:327–333.
26. Wu W-C, Lien R, Liao P-J, Wang N-K, Chen Y-P, A Chao, et al. Serum levels of vascular endothelial growth factor and related factors after intravitreous bevacizumab injection for retinopathy of prematurity. JAMA Ophthalmol 2015;133;391–397.
27. Hong YR, Kim YH, Kim SY, Nam GY, Cheon HJ, Lee SJ. Plasma concentrations of vascular endothelial growth factor in retinopathy of prematurity after intravitreal bevacizumab injection. Retina 2015;35:1772–1777.
28. Yang CH. Anti-vascular endothelium growth factor therapy for retinopathy of prematurity: a continuing debate. Taiwan J Ophthalmol 2012;2:115–116.
29. Martínez-Castellanos MA, Schwartz S, Hernández-Rojas ML, Kon-Jara VA, García-Aguirre G, Guerrero-Naranjo JL, et al. Long-term effect of anti-angiogenic therapy for retinopathy of prematurity up to 5 years of follow up. Retina 2013;33:329–338.
30. Morin J, Mai Luu T, Superstein R, Ospina LH, Lefebvre F, Simard M-N, et al. Neurodevelopmental outcomes following bevacizumab injections for retinopathy of prematurity. Pediatrics 2016;137:4.
31. Wu LH, Yang YH, Lin CH, Lin YJ, Cheng CL. Hypotension associated with intravitreal bevacizumab therapy for retinopathy of prematurity. Pediatrics 2016;137:e20152005.
32. Fernandez MP, Berrocal AM, Goff TC, Ghassibi MP, Armitage Harper C, Chou E, et al. Histopathologic characterization of the expression of vascular endothelial growth factor in a case of retinopathy of prematurity treated with ranibizumab. Am J Ophthalmol 2017;176:134–140.
33. Moran S, O’Keefe M, Hartnett C, Lanigan B, Murphy J, Donoghue V. Bevacizumab versus diode laser in stage 3 posterior retinopathy of prematurity. Acta Ophthalmol 2014;92:e496–e497.
34. Araz-Ersan B, Kir N, Tuncer S, Aydinoglu-Candan O, Yildiz-Inec D, Akdogan B, et al. Preliminary anatomical and neurodevelopmental outcomes of intravitreal bevacizumab as adjunctive treatment for retinopath of prematurity. Curr Eye Res 2014;15:1–7.
35. Hartnett ME, Penn JS. Mechanisms and management of retinopathy of prematurity. N Engl J Med 2012;367:2515– 2526.
36. Quinn GE, Dobson V, Hardy RJ, Tung B, Palmer EA, Good WV, et al. Visual field extent at 6 years of age in children who had high-risk prethreshold retinopathy of prematurity. Arch Ophthalmol 2011;129:127–132.
37. O’Connor AR, Wilson CM, Fielder AR. Ophthalmological problems associated with preterm birth. Eye 2007;21:1254–1260.
38. Larsson E, Rydberg A, Holmstrom G. Contrast sensitivity in 10 year old preterm and full term children: a population based study. Br J Ophthalmol 2006;90:87–90.
39. Dobson V, Quinn GE, Abramov I, Hardy RJ, Tung B, Siatkowski RM, et al. Color vision measured with pseudoisochromatic plates at five-and-a-half years in eyes of children from the CRYO-ROP study. Invest Ophthalmol Vis Sci 1996;37:2467–2474.
40. Hwang CK, Hubbard GB, Hutchinson AK, Lambert SR. Outcomes after intravitreal bevacizumab versus laser photocoagulation for retinopathy of prematurity: a 5-year retrospective analysis. Ophthalmology 2015;122:1008– 1015.
41. Geloneck MM, Chuang AZ, Clark WL, Hunt MG, Norman AA, Packwood EA, et al. Refractive outcomes following bevacizumab monotherapy compared with conventional laser treatment: a randomized clinical trial. JAMA Ophthalmol 2014;132:1327–1333.
42. Kuo HK, Sun IT, Chung MY, Chen YH. Refractive error in patients with retinopathy of prematurity after laser photocoagulation or bevacizumab monotherapy. Ophthalmologica 2015;234:211–217.
43. Gunay M, Celik G, Gunay BO, Aktas A, Karatekin G, Ovali F. Evaluation of 2-year outcomes following intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity. Arq Bras Oftalmol 2015;78:300–304.
44. Isaac M, Mireskandari K, Tehrani N. Treatment of type 1 retinopathy of prematurity with bevacizumab versus laser. J AAPOS 2015;19:140–144.
45. Tan Q-Q, Christiansen SP, Wang J. Development of refractive error in children treated for retinopathy of prematurity with anti-vascular endothelial growth factor (anti-VEGF) agents: a meta-analysis and systematic review. PLoS One 2019;14:12.