Repeated intravitreal ranibizumab for reactivated retinopathy of prematurity after intravitreal ranibizumab monotherapy: vascular development analysis

Purpose To evaluate the retinal vascularization of repeated intravitreal ranibizumab (IVR) for reactivated retinopathy of prematurity (ROP) treated with IVR monotherapy. Methods The retrospective study reviewed ROP infants who accepted IVR injection as the first treatment in our department from January 2017 to December 2018. The ratio of the distance from the center of the optic disc to the border of the vascularized zone (DB) to the distance from the center of the disc to the fovea (DF) was used for the vascular outgrowth analysis. Results Seventy-eight infants were included in the study. A total of 54.3% of the reactivated ROP patients could achieve complete vascularization after repeated IVR injections. Gestational age (GA) > 29 weeks and a temporal DB/DF ratio >= 3 in the first IVR were potential predictors for complete retinal vascularization after IVR monotherapy. The temporal DB/DF ratio >= 3.6 in the second IVR injection was a potential predictor for complete retinal vascularization after repeated IVR for ROP reactivation. Conclusions Reactivated ROP after IVR monotherapy can be treated successfully with repeated IVR injections. GA and temporal DB/DF ratio are potential predictors of complete retinal vascularization in ROP infants treated with IVR. Key messages ROP reactivation is common in ROP treated with intravitreal anti-VEGF drugs. ROP reactivation after the first IVR can be treated successfully with repeated IVR treatments. ROP with gestational age (GA) <= 29 weeks or a temporal DB/DF ratio 3 in the first IVR has a higher risk of ROP reactivation after the first IVR and requires repeated IVR treatments. ROP reactivation with a temporal DB/DF ratio >= 3.6 in the second IVR is more likely to achieve complete retinal vascularization after the second IVR.