Intravitreal anti-VEGF treatment for retinopathy of prematurity in infants with active adenoviral keratoconjunctivitis

Session Details

Session Title: Free Paper Session 24: Vascular Diseases & Diabetic Retinopathy VII

Session Date/Time: Sunday 10/09/2017 | 10:00-11:30

Paper Time: 10:48

Venue: Room 117

First Author: : Y.Ko├žluk TURKEY

Co Author(s): :    E. Alyamac Sukgen                             

Abstract Details

Purpose:

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness in developed and developing countries. Adenovirus outbreaks at neonatal intensive care units (NICUs) have been reported in numerous studies and the association between AKC and ROP examinations has been noted in the literature. So, AKC is an important comorbid factor particularly in infants with treatment-requiring ROP. Various studies have reported positive outcomes in relation to anti-VEGF agents used in ROP treatment.The purpose of this study was to evaluate the results of intravitreal anti-VEGF treatment for ROP in infants with active AKC during an epidemic keratoconjunctivitis outbreak in our centre.

Setting:

This single-centre retrospective study was conducted at tertiary centre for the screening and treatment of ROP in the Adana Numune Training and Research Hospital.

Methods:

A retrospective analysis was performed using the medical records of all infants treated with intravitreal injections of anti-VEGF agents during an adenoviral keratoconjunctivitis (AKC) outbreak which previously reported in the literature at a tertiary centre for treatment of retinopathy of prematurity. The outbreak of AKC occurred between January 2015 and September 2015 in the centre. The number of patients examined routinely was decreased during the outbreak, and all preventive precautions were taken. However, control of the outbreak at the centre was more difficult because, being a reference centre for the treatment of ROP, it continued to provide services. The effects and potential ocular and systemic adverse effects of anti-VEGF agents (bevacizumab, ranibizumab or aflibercept) and laser photocoagulation (LPC) were explained to the families, and treatment choice was made according to their preferences.

Results:

Four hundred and forty-five infants were screened retrospectively during this outbreak period. Fourteen percent (61/445) of infants required ROP treatment with either LPC or intravitreal anti-VEGF therapy. During the AKC outbreak, 22 infants were treated with anti-VEGF agents for treatment-requiring ROP. The infants were divided into two groups. Group-1 included nine infants (18 eyes) with AKC, while Group-2 included 13 infants (26 eyes) without AKC. ROP and plus disease displayed a significant regression within two days after the intravitreal injections in all the patients in both groups. Also, no serious complications such as endophthalmitis, retinal detachment, cataract or intravitreal haemhorrage were observed after the treatment and there were no statistically significant differences between the groups in terms of postoperative complications.

Conclusions:

Treatment-requiring ROP should be treated urgently and timely and appropriate intervention is very important. However, to apply laser photocoagulation (LPC) is technically difficult at every step. Due to eyelid edema and chemosis, the eyelid speculum could not sufficiently open the eyes. The fundus could not be seen easily and the laser spots could not focus on the retinas because of the corneal haze and haemhorrage from conjonctival membranes. If appropriate treatment is not given timely in cases of ROP, retinal detachment can be seen. Therefore, during this outbreak, we had to take an unusual descision like choosing intravitreal injection of anti-VEGF agents for treatment of ROP. The results of this study show that favorable outcomes without serious ocular complications could be obtained via intravitreal injections of anti-VEGF agents in infants with active AKC.

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