Combination of photocoagulation and intravitreal injection ofpegaptanib or bevacizumab in treatment of stage 3 retinopathyof prematurity in zone I or posterior zone II

Purpose: To report results of retrospective, consecutive, noncomparative case series of moderate and severe stage 3 retinopathy of prematurity (ROP) in zone I or posterior zone II treated by bilateral intravitreal injections of pegaptanib or bevacizumab and diode laser photocoagulation. 32 infants weighing from 545 g to 1,150 g at birth (mean, 742.8 g) with gestational ages from 22 weeks to 28 weeks (mean, 24.1 weeks) received intravitreal injections of pegaptanib (0,15mg) or bevacizumab (0.625 mg ) at 9.0 weeks to 14.0 weeks of age (mean, 10.5 weeks) and after 1 week had diode laser therapy. Length of follow-up was from 15.0 weeks to 95.0 weeks (mean, 56.5 weeks). Only patients with bilateral moderate or severe stage 3 ROP in Zone I or posterior Zone II with or without plus-disease were considered candidates for this study. All cases were photographed by the RetCam Imaging System immediately before and 1week, 1,2, and 3months after the bilateral treatment. Each infant underwent photography at the time of the most recent examination to demonstrate the extent of continued vascular growth anteriorly from the original location of moderate or severe stage. All 64 eyes were treated successfully (no retinal detachment, macular ectopia, high myopia, anisometropia, or other ocular abnormalities) to induce regression of acute ROP with only 1 injection and 1 laser treatment. These results are promising, without any early local or systemic complications. Intravitreal injection of pegaptanib or bevacizumab combinated with photocoagulation was safe and effective in treating stage 3 ROP in zone I and posterior zone II in this series of 32 infants. A prospective, randomized, controlled, clinical trials with more patients would be initiated to investigate and confirm results of this promising treatment combination.