Delayed recurrent neovascularization and persistent avascular retina following intravitreal bevacizumab for retinopathy of prematurity

Abstract

Purpose: Intravitreal bevacizumab is becoming increasingly popular in the treatment of retinopathy of prematurity. Ophthalmologists should be aware of potential complications and failures of this treatment.

Methods: Case report and literature review.

Results: A premature infant born at 23 weeks gestational age developed zone 1 stage 3 retinopathy of prematurity with plus disease in both eyes. At 36 weeks postmenstrual age, the patient was treated with intravitreal bevacizumab and the neovascularization initially regressed. However, the patient's peripheral avascular retina persisted and at 53 weeks postmenstrual age, the patient developed recurrent neovascularization and plus disease of both eyes requiring treatment with laser photocoagulation. The infant showed regression of neovascularization and improvement of plus disease after laser, but contraction of fibroglial tissue caused a tractional retinal detachment. The retina was successfully reattached after pars plana vitrectomy and membrane peel.

Conclusion: Infants receiving intravitreal bevacizumab as primary treatment for retinopathy of prematurity can show initial regression of neovascularization with delayed recurrence of neovascularization and persistence of peripheral avascular retina greater than 4 months after initial treatment. Ophthalmologists following infants with retinopathy of prematurity treated with intravitreal bevacizumab should be aware of the possibility of delayed recurrent neovascularization and subsequent complications.