Acute contraction of the proliferative membrane after an intravitreal injection of bevacizumab for advanced retinopathy of prematurity

Despite the recent reports describing the benefits of the intravitreal injection of bevacizumab (IVB) to treat ocular neovascular disorders, including retinopathy of prematurity (ROP), the possible adverse effects of this therapy must also be described. We report here a case of advanced ROP which showed an acute contraction of the proliferative membrane after an intravitreal injection of bevacizumab.

A female infant born at 23 weeks of gestation with a birth weight of 598 g was referred to the ophthalmologist at 4 weeks of age. With funduscopic examinations, broad avascular retinas were found in both eyes. Since the ROP had progressed to stage 3, zone 1 with plus disease in both eyes, retinal photocoagulation was performed at 10 weeks of age. Despite the adequate photocoagulation therapy, the proliferation progressed further, and partial tractional retinal detachment (TRD) occurred in the right eye, classified as stage 4A with plus disease. After extensive discussion with the parents about the risks and benefits of IVB as an alternative therapy, they consented to the treatment. Under general anesthesia, an intravitreal injection of 0.4 mg bevacizumab was performed at 14 weeks of age.

The following day, the vascular component of the fibrovascular membrane (FVM) regressed, and acute fibrosis occurred. However, the ring-shaped FVM contracted centripetally, which caused a deterioration of the TRD. The contraction of the FVM progressed until 7 days after IVB, and resulted in a funnel-like retinal detachment at the posterior retina. The other eye also showed TRD at 19 weeks of age classified as stage 4B, which necessitated a vitrectomy. No systemic complications were noted before and after the treatment.

IVB is a useful therapy to maintain aggressive ROP. However, IVB might cause TRD progression in some specific cases.