Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Ophthalmology
Published in: International Ophthalmology 4/2020

01-04-2020 | Bevacizumab | Original Paper

Characteristics of ‘sawtooth shunt’ following anti-vascular endothelial growth factor for aggressive posterior retinopathy of prematurity

Authors: Tapas Ranjan Padhi, Taraprasad Das, Prabhjot Kaur, Samir Sutar, Ashish Khalsa, Rohit Modi, Hasnat Ali, Lingaraj Pradhan, Subhadra Jalali

Published in: International Ophthalmology | Issue 4/2020

Login to get access

Abstract

Objective

To explore the characteristics of ‘sawtooth shunts (STS)’ following intravitreal anti-vascular endothelial growth factors (anti-VEGF) for aggressive posterior retinopathy of prematurity (AP-ROP).

Design

Prospective observational study.

Methods

In a prospective observational study, 45 eyes of 24 babies receiving intravitreal anti-VEGF for AP-ROP or hybrid ROP were analyzed. Anti-VEGF molecule and doses: bevacizumab (0.62 mg or ½ IVB, n = 30 eyes; 0.25 mg or 1/5IVB, n = 9 eyes; 0.12 mg or 1/10 IVB, n = 1 eye); or ranibizumab (0.25 mg or ½IVR, n = 3 eyes; 0.1 mg or 1/5IVR, n = 2 eyes). They were followed every 1–2 week till disease regression with or without laser treatment. Development of STS, its variants, characteristics, timeline, and final outcomes was analyzed.

Results

STS occurred in 26 (57.7%) eyes at 1–6 weeks following anti-VEGF injections and persisted for 1–14 weeks. While the shunt regressed spontaneously in half of the treated eyes (n = 13) with anti-VEGF alone, the other half (n = 13) required additional laser because of either non-compliance (n = 9) or recurrence (n = 4).

Conclusion

The STS was observed to be an important retinal vascular change seen in infants treated with intravitreal anti-VEGF at half adult doses. It warrants further studies to explore the association between STS and its association with disease recurrence or regression.
Literature
1.
An International Committee for the Classification of Retinopathy of Prematurity (2005) The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 123:991–999CrossRef
2.
Katz X, Kychenthal A, Dorta P (2000) Zone I retinopathy of prematurity. JAAPOS 4:373–376
3.
Drenser KA, Trese MT, Capone A Jr (2010) Aggressive posterior retinopathy of prematurity. Retina 30(4 Suppl):S37–40CrossRef
4.
Sanghai G, Dogra MR, Dogra M et al (2012) A hybrid form of retinopathy of prematurity. Br J Ophthalmol 96(4):519–522CrossRef
5.
Yetik H, Gunay M, Sirop S et al (2015) Intravitreal bevacizumab monotherapy for type 1 prethreshold, threshold, and aggressive posterior retinopathy of prematurity- 27 month follow-up results from Turkey. Graefes Arch Clin Exp Ophthalmol 253:1677–1683CrossRef
6.
Padhi TR, Das T, Rath S et al (2016) Serial evaluation of retinal vascular changes in infants treated with intravitreal bevacizumab for aggressive posterior retinopathy of prematurity in Zone I. Eye 30(3):392–399CrossRef
7.
Wu L, Arevalo JF, Maia M et al (2009) Comparing outcomes in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration treated with two different doses of primary intravitreal bevacizumab: results of the Pan-American Collaborative Retina Study Group (PACORES) at the 12-month follow-up. Jpn J Ophthalmol 53(2):125–130CrossRef
8.
Brown DM, Kaiser PK, Michels M et al (2006) ANCHOR study group ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 355(14):1432–1444CrossRef
9.
Avery RL, Bakri SJ, Blumenkranz et al (2014) Intravitreal injection technique and monitoring: updated guidelines of an expert panel. Retina 34:S1–S18CrossRef
10.
Wright LM, Vrcek IM, Scribbick FW et al (2017) Technique for infant intravitreal injection in treatment of retinopathy of prematurity. Retina 37:2188–2190CrossRef
11.
Wallace DK, Kraker RT, Freedman SF, Son AK et al (2017) Assessment of lower doses of intravitreous bevacizumab for retinopathy of prematurity: a Phase 1 Dosing Study. JAMA Ophthalmol 135(6):654–656CrossRef
12.
Fan Q, TeoYY Saw SM (2011) Application of advanced statistics in ophthalmology. Inves Ophthalmol Vis Sci 52:6059–6065CrossRef
13.
Flynn JT, Cassady J, Essner D et al (1979) Fluorescein angiography in retrolental fibroplasia: experience from 1969–1977. Ophthalmology 86:1700–1723CrossRef
14.
Morizane H (1976) Initial sign and clinical course of the most severe form of acute proliferative retrolental fibroplasias (type II) [in Japanese]. Nippon GankaGakkaiZasshi 80:54–61
15.
Yokoi T, Hiraoka M, Miyamoto M et al (2009) Vascular abnormalities in aggressive posterior retinopathy of prematurity detected by fluorescein angiography. Ophthalmology 116:1377–1382CrossRef
16.
Harper CA III, Wright LM, Young RC et al (2017) Fluorescein angiographic evaluation of peripheral retinal vasculature after primary intravitreal ranibizumab for retinopathy of prematurity. Retina 39:1–6
17.
Park SW, Jung HH, Heo H (2014) Fluorescein angiography of aggressive retinopathy of Prematurity treated with intravitreal anti-VEGF in large preterm babies. Acta Ophthalmol 92:810–813CrossRef
18.
Lepore D, Quinn GE, Molle F, Baldascino A, Orazi L, Sammartino M et al (2014) Intravitreal bevacizumab versus laser treatment in type 1 retinopathy of prematurity: report on fluorescein angiographic findings. Ophthalmology 121:2212–2219CrossRef
19.
Lorenz B, Stieger K, Jager M et al (2017) on behalf of the Giessen Cooperative ROP study group. Retinal vascular development with 0.312 mg intravitreal bevacizumab to treat severe posterior Retinopathy of Prematurity a longitudinal fluorescein angiographic study. Retina 37:97–111CrossRef
20.
Tahija SG, Hersetyati R, Lam GC et al (2014) Fluorescein angiographic observations of peripheral retinal vessel outgrowth in infants after intravitreal injection of bevacizumab as sole therapy for zone I and posterior zone II retinopathy of prematurity. Br J Ophthalmol 98:507–512CrossRef
21.
Henaine-Berra A, Garcia-Aguirre G, Quiroz-Mercado H et al (2014) Retinal fluorescein angiographic changes following intravitreal anti-VEGF therapy. JAAPOS 18:120–123
22.
23.
Metadata
Title
Characteristics of ‘sawtooth shunt’ following anti-vascular endothelial growth factor for aggressive posterior retinopathy of prematurity
Authors
Tapas Ranjan Padhi
Taraprasad Das
Prabhjot Kaur
Samir Sutar
Ashish Khalsa
Rohit Modi
Hasnat Ali
Lingaraj Pradhan
Subhadra Jalali
Publication date
01-04-2020
Publisher
Springer Netherlands
Published in
International Ophthalmology / Issue 4/2020
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI
https://doi.org/10.1007/s10792-019-01269-4

Other articles of this Issue 4/2020

International Ophthalmology 4/2020 Go to the issue

Review

Albrecht von Graefe (1828–1870) and his contributions to the development of ophthalmology

Original Paper

Comparison of 27-gauge versus 25-gauge vitrectomy results in patients with epiretinal membrane: 6-month follow-up

Original Paper

The association of choroidal thickness with rheumatoid factor and anti-cyclic citrullinated peptide in rheumatoid arthritis

Review

Thyroid eye disease: current and potential medical management

Review

Analysis from the perspective of cilia: the protective effect of PARP inhibitors on visual function during light-induced damage

Original Paper

Long-term outcomes of the intravitreal injection of ranibizumab for the treatment of choroidal neovascularization secondary to pathologic myopia