Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Sep 9, 2023; 12(4): 220-229
Published online Sep 9, 2023. doi: 10.5409/wjcp.v12.i4.220
Safety and efficacy of intravitreal anti vascular endothelial growth factor for severe posterior retinopathy of prematurity with flat fibrovascular proliferation
Puja Maitra, Subramaniam Prema, Venkatapathy Narendran, Parag K Shah
Puja Maitra, Subramaniam Prema, Venkatapathy Narendran, Parag K Shah, Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore 641014, Tamil Nadu, India
Author contributions: Shah PK and Narendran V designed the research study; Maitra P and Prema S performed the research; Narendran V contributed towards analytic tools; Maitra P, Prema S and Shah PK analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Aravind Eye Hospital Institutional Ethics Committee (Approval No. RET201300423).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at email address: Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Parag K Shah, DNB, Professor, Pediatric Retina & Ocular Oncology, Aravind Eye Hospital, Avinashi Road, Coimbatore 641014, Tamil Nadu, India.
Received: May 5, 2023
Peer-review started: May 5, 2023
First decision: June 19, 2023
Revised: June 26, 2023
Accepted: July 7, 2023
Article in press: July 7, 2023
Published online: September 9, 2023

Intravitreal anti-vascular endothelial growth factor (IVA) injection is known to cause contraction of fibrovascular proliferation (FVP), when present in severe retinopathy of prematurity (ROP).


To assess the structural outcomes of IVA injection in the treatment of severe posterior ROP with significant FVP.


It was a retrospective study in which 36 eyes of 18 preterm babies who developed > 4 clock hours of FVP in zone I or posterior zone II, were treated with either intravitreal 0.625 mg bevacizumab or intravitreal 0.2 mg of ranibizumab. Favorable structural outcome included resolution of plus disease and FVP without the development of tractional retinal detachment. Secondary outcome measure included either full retinal maturation at follow-up or development of recurrent disease requiring additional treatment. Adverse outcomes included progression to retinal detachment.


The mean gestational age of the 18 preterm babies was 30 wk (range 27-36), and mean birth weight was 1319 g (range 650-1980 g). Mean post-menstrual age (PMA) at the time of primary treatment was 35.5 wk (range 31-41 wk). All eyes showed regression of plus disease and FVP. 5 eyes of 3 babies showed reactivation of disease and were treated with repeat IVA (n = 2 eyes) or peripheral laser photocoagulation (n = 3 eyes) respectively. 16 out of 36 (44%) reached retinal vascular maturation at final follow up at 5 years.


There was good resolution of severe posterior ROP with FVP with IVA, with retinal maturity of 44% at 5 year follow-up and a reactivation rate of 13.8%. When the IVA injection is given prior to 37 wk PMA, while disease is in phase 2, it is less likely to cause contracture of pre-existing FVP.

Keywords: Retinopathy of prematurity, Anti-vascular endothelial growth factor injection, Contraction, Crunch phenomenon

Core Tip: This is a retrospective study to evaluate if anti-vascular endothelial growth factor injection could cause contraction of preexisting fibrovascular proliferation when present in severe retinopathy of prematurity.