Retinal fluorescein angiographic changes following intravitreal anti-VEGF therapy.
OBJECTIVE
To describe the retinal vascular morphology in eyes injected with intravitreal bevacizumab for treatment-requiring retinopathy of prematurity (ROP).


METHODS
In this prospective, nonrandomized case series, fundus photographs and fluorescein angiography in patients diagnosed with stage 3 threshold or prethreshold ROP, were obtained immediately before and 1 month after injection of 0.03 cc (0.75 mg) of intravitreal bevacizumab using wide-field digital pediatric imaging system.


RESULTS
A total of 47 eyes of 26 patients were included. Before treatment, fluorescein angiography showed vascular abnormalities, including capillary nonperfusion throughout and shunting in the vascularized retina, demarcation line, limited vessel development, new vessels leakage, avascular periphery and absence of foveal avascular zone. After intravitreal bevacizumab, fluorescein angiography showed involution of the neovascularization, flattening of the demarcation line and subsequent growth of vessels to the capillary-free zones. During the following weeks large areas devoid of microvessels were seen as well as vascular remodeling with uneven spacing of the retinal capillaries and vascular loops in the areas that were previously devoid of vessels. In some patients, retinal vessels in the far periphery never developed: patients with these findings did not subsequently develop pathological neovascularization.


CONCLUSIONS
In this study cohort, patients showed improvement of their abnormal vascular findings after intravitreal bevacizumab, however even when the vascular pattern remained abnormal, there was creation of small vessels, establishment of directional flow, maturation of retinal vessels, and adjustment of vascular density.
Retina Department, Asociacion Para Evitar la Ceguera en Mexico, I.A.P. Hospital "Dr. Luis Sanchez Bulnes", Coyoacan, Mexico City.
Andree
A
Henaine-Berra
Retina Department, Asociacion Para Evitar la Ceguera en Mexico, I.A.P. Hospital "Dr. Luis Sanchez Bulnes", Coyoacan, Mexico City.
Gerardo
G
Garcia-Aguirre
Ophthalmology Department, Denver Health Medical Center, School of Medicine, University of Colorado, Denver, CO.
Hugo
H
Quiroz-Mercado
Retina Department, Asociacion Para Evitar la Ceguera en Mexico, I.A.P. Hospital "Dr. Luis Sanchez Bulnes", Coyoacan, Mexico City. Electronic address: mamc@dr.com.
Maria Ana
MA
Martinez-Castellanos
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D001724:Birth Weight; D005260:Female; D005451:Fluorescein Angiography; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D058449:Intravitreal Injections; D008297:Male; D018919:Neovascularization, Physiologic / Q000502:physiology; D011446:Prospective Studies; D015861:Retinal Neovascularization / Q000175:diagnosis / Q000188:drug therapy; D012171:Retinal Vessels / Q000503:physiopathology*; D012178:Retinopathy of Prematurity / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab