AUTHOR=Zhang Xuerui , Peng Jie , Yang Yuan , Liu Yongqing , Zhang Wenting , Gu Victoria Y. , Liu Huanyu , Xiao Haodong , Yin Jiawei , Xu Yu , Zhao Peiquan 

TITLE=Vascular development analysis: a study for tertiary anti-vascular endothelial growth factor therapy after second reactivation of retinopathy of prematurity

JOURNAL=Frontiers in Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1421894

DOI=10.3389/fmed.2024.1421894

ISSN=2296-858X

ABSTRACT=To observe the vascular development results of tertiary anti-vascular endothelial growth factor (anti-VEGF) therapy following spontaneous second reactivation of retinopathy of prematurity (ROP).Methods: This retrospective study included 22 infants (42 eyes) with Type 1 or aggressive ROP (A-ROP) who received three anti-VEGF drug treatments for ROP from January 2018 to December 2022. The vascular growth, possible associated risk factors, and the retinal vascularization (DB/DF ratio) were assessed.The mean follow-up was 17.6 months. After the 3 rd intravitreal injection, seven eyes showed complete vascularization (Group 1), while the remaining 35 eyes demonstrated persistent avascular retina (PAR) (Group 2). In Group 2, 17 eyes maintained a stable state and were classified in the regression subgroup. The other 18 eyes developed a 3 rd reactivation (reactivation subgroup) and were treated with laser photocoagulation (LPC).Birth weight (BW) was significantly lower in Group 2 than in Group 1 (p < 0.001). The decision tree analysis shows that only infants weighing more than 1250g (17.50%) had a chance to achieve complete retinal vascularization. The possibility of PAR was higher in patients with BW <1250g than ≥1250g (70.00% vs. 12.50%). In addition, most infants with BW≥1290g and initial ROP disease in Zone I or posterior Zone II developed PAR.Tertiary IVR can successfully treat a second ROP reactivation and improve peripheral retinal vascularization. BW is the most significant factor related to complete retinal vascularization. Our decision tree model may be helpful in predicting the prognosis of anti-VEGF drugs in the event of a second ROP reactivation.