Reactivation of retinopathy of prematurity after intravitreal bevacizumab monotherapy in aggressive posterior retinopathy of prematurity

Aims: The aim of the study was to identify the risk factors and timing for the reactivation of retinopathy of prematurity (ROP) after intravitreal bevacizumab (IVB) in aggressive posterior retinopathy of prematurity (APROP). Materials and Methods: A retrospective study to analyze the outcome of 24 eyes of 12 infants treated with IVB monotherapy (0.625 mg) was done. Data were analyzed regarding the initial response to IVB, the incidence of ROP reactivation, timing, location, and stage of reactivation. Gestational age, postmenstrual age, and other neonatal comorbid risk factors were compared between the reactivation and those without reactivation after IVB. Results: The mean follow-up time was 50.2 ± 1.4 weeks after IVB. Reactivation was identified in 8 (33.3%) eyes. Reactivation in zone I was seen in only two eyes and zone II reactivation was present in six eyes. The mean postmenstrual age at the time of recurrence was 44.0 ± 1.15 weeks (range: 43–45). The mean time between initial treatment and treatment-requiring recurrence was 11.8 ± 0.9 weeks. Multiple pregnancy, low birth weight, sepsis, and necrotizing enterocolitis were significantly associated with ROP reactivation. None of our patients progressed to retinal detachment after laser treatment for reactivation. Conclusions: Although IVB treatment is effective in inducing the regression of APROP, the effect may be transient. The recurrence of ROP should be carefully watched in a long-term follow-up after IVB monotherapy, particularly in the first 12 weeks after IVB.