Foveal Development After Use of Bevacizumab for Aggressive Posterior Retinopathy of Prematurity.

Foveal development can occur after intravitreal bevacizumab (IVB) treatment for aggressive posterior retinopathy of prematurity (APROP). A 1,310 g male twin, born at 31 weeks, was diagnosed with APROP and undeveloped fovea at 33 weeks. IVB was injected in both eyes. Unfortunately, multiple surgical interventions were required to treat retinal detachment in the left eye, at which time, foveal development was studied in the right eye. Imaging revealed development of foveal capillary ring, avascular zone, and shallow pit. Although bevacizumab is an inhibitor of angiogenesis and delays vascular advancement, development of foveal capillary vascular network with foveal avascular zone and pit can proceed despite multiple treatments. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e185-e187.].

PROPHYLACTIC PERIPHERAL LASER AND FLUORESCEIN ANGIOGRAPHY AFTER BEVACIZUMAB FOR RETINOPATHY OF PREMATURITY.

PURPOSE: To report reactivation rate after bevacizumab treatment for retinopathy of prematurity (ROP) in eyes with classic ROP (CROP) versus aggressive posterior ROP (APROP) and to report peripheral fluorescein angiography findings in these eyes. METHODS: Retrospective chart review was conducted on consecutive infants treated with bevacizumab for ROP, followed by fluorescein angiography and prophylactic laser to persistent avascular retina. RESULTS: Sixty-four eyes of 33 patients were included. Mean gestational age was 25 weeks with mean birth weight of 674 g. Mean follow-up was 125 weeks post-menstrual age (PMA). Reactivation requiring treatment after initial bevacizumab was more common in eyes with APROP (8/16) than with CROP (2/48; P < 0.0001). At mean 73 weeks PMA, eyes with APROP had more avascular retina (mean 4.4 disk diameters vs. 2.6 disk diameters; P = 0.0004) and higher percentage of leakage (11/11 eyes vs. 22/38 eyes; P = 0.01) on fluorescein angiography than in eyes with CROP. Unfavorable outcome occurred in 1 of 16 eyes with APROP and in no eyes with CROP. No eye that underwent prophylactic laser after bevacizumab had a poor structural outcome. CONCLUSION: In our study, bevacizumab-treated eyes with APROP have a higher likelihood of recurrence and larger area of persistent nonperfusion than in eyes with CROP. Treatment of ROP with bevacizumab followed by prophylactic laser has a low rate of unfavorable structural outcome.

CANDIDA ENDOPHTHALMITIS FROM THE REACTIVATION OF A DORMANT LENTICULAR FUNGAL ABSCESS IN A PREMATURE INFANT.

BACKGROUND/PURPOSE: To report a case of fungal endophthalmitis from reactivation of a dormant lenticular fungal abscess in a severely premature infant. METHODS: Single retrospective case report. RESULTS: A female born at 23 and 6/7 weeks and weighing 620 g was diagnosed at age 29 weeks post menstrual age with persistent tunica vasculosa lentis, lenticular opacity, and aggressive posterior retinopathy of prematurity, and received bilateral intravitreal injection of bevacizumab. At the time of injection she was receiving systemic antibiotics for sepsis and fungemia. The retinopathy of prematurity regressed, as did the tunica vasculosa lentis, but a small plaque remained on the lens. At 5.5 months of age, patient presented with hypopyon and elevated intraocular pressure. Culture of intraocular fluid demonstrated Candida albicans. CONCLUSION: Candida lenticular abscess is a rare complication of systemic fungemia in premature infants. Bevacizumab-induced regression of tunica vasculosa lentis may have decreased the ability of systemically administered antifungal medications to reach the colonized lens.

CONCURRENT SCLERAL BUCKLE AND INTRAVITREAL BEVACIZUMAB FOR ADVANCED RETINOPATHY OF PREMATURITY-RELATED RETINAL DETACHMENT.

BACKGROUND: The preoperative use of intravitreal bevacizumab in Stage 4 or 5 retinopathy of prematurity (ROP) can reduce vascular endothelial growth factor load and bleeding risk; however, it can induce traction and exacerbate a tractional retinal detachment. Concurrent placement of a scleral buckle may reduce these risks and obviate future vitrectomy. METHODS: A retrospective analysis of eyes treated for Stage 4 and 5 ROP with concurrent intravitreal bevacizumab and scleral buckle was performed. Retinal reattachment and need for vitrectomy were studied. RESULTS: Thirteen eyes from 10 infants were treated with concurrent intravitreal bevacizumab and scleral buckle. Nine eyes were Stage 4a, 2 were Stage 4b, and 2 were Stage 5. All eyes with Stage 4 ROP achieved macular attachment at last follow-up. All the eyes with 4a ROP achieved retinal reattachment: 4 (44.4%) with buckle alone and 5 (55.6%) with subsequent vitrectomy. All 4 eyes with Stage 4b or 5 ROP required vitrectomy. CONCLUSION: Concurrent intravitreal bevacizumab and scleral buckle may serve as a bridge to vitrectomy and, in some instances, may obviate the need for subsequent intervention.

Directed conjunctival biopsy and impact of histologic sectioning methodology on the diagnosis of ocular sarcoidosis.

BACKGROUND: Sarcoidosis is an idiopathic, multi-system, granulomatous disease with well-described ocular manifestations. However, other uveitic etiologies can manifest in a similar fashion, and ocular disease may precede systemic manifestations. Definitive diagnosis requires histologic confirmation of non-caseating granulomatous inflammation. This study reports the diagnostic yield of directed biopsy of conjunctival follicles in patients with uveitis suspected to be secondary to sarcoidosis, and compares an institutional standard tissue sectioning method to a multi-plane technique. RESULTS: A retrospective analysis was performed of all patients who underwent directed conjunctival biopsy for suspected ocular sarcoidosis. A total of eight patients were identified; all were females. Directed conjunctival biopsy was positive in three of seven patients using standard histologic processing method, a yield of 43%. Using the multi-plane technique increased the cumulative yield to 63%. CONCLUSIONS: Directed conjunctival biopsy is a minimally invasive, cost-effective, and moderately high yield method of diagnosing ocular sarcoidosis. Using a multi-plane sectioning method may increase biopsy yield when standard sectioning techniques are negative.

Minimal refractive change induced by sutureless 23- and 25-gauge pars plana vitrectomy.

BACKGROUND AND OBJECTIVE: This study reports the induced refractive error after 23- and 25-gauge (G) pars plana vitrectomy (PPV). PATIENTS AND METHODS: In this non-randomized retrospective case series, refractive status was assessed with an autokeratorefractometer 1 week or more before and 6 months after surgery. Patients who had suture placement to close the sclerotomies were excluded from the study. RESULTS: Among the 50 patients (50 eyes), the mean age was 63 years (range: 42 to 76 years) and 57% were female. Thirty eyes underwent 23-G PPV and 20 eyes underwent 25-G PPV. The mean refractive change was +0.50 diopters (D) sphere, +0.25 D cylinders and the mean axis of cylinder change was 6° for the 23-G group; the mean refractive change was +0.12 D sphere, +0.12 D cylinders and the mean axis of cylinder change was 17° for the 25-G group. CONCLUSION: Following sutureless small-gauge vitrectomy, there were mild and minimally significant refractive changes in the 23-G and 25-G groups from baseline.

Rebound neovascularization during bevacizumab therapy.

PURPOSE: To present two cases of rebound neovascularization after bevacizumab treatment. METHODS: Observational, retrospective case report. A 42-year-old male patient with proliferative diabetic retinopathy and a 68-year-old man with central retinal vein occlusion received treatment with panretinal photocoagulation and intravitreal bevacizumab. RESULTS: Both patients showed significant improvement with regression of neovascular vessels after treatment. Nevertheless, on cessation of treatment because of loss to follow-up, both presented with massive neovascularization. This was significantly more severe than the initial presentation. CONCLUSION: After initial suppression of vascular endothelial growth factor by bevacizumab, a rebound phenomenon of neovascularization can occur.