Delhi Journal of Ophthalmology

Management of Retinopathy of Prematurity: Quest for the Best

Sarita Beri1, Siddharth Madan1, Anurag Shandil1, Sushma Nangia2, Rajiv Garg1, Prachi Virmani1
1Department of Ophthalmology, Lady Hardinge Medical College and Associated Hospitals, University of Delhi, New Delhi, India 
2Department of Neonatology, Kalawati Saran Children’s Hospital, Lady Hardinge Medical College, New Delhi, India

Editor-in-Chief, Delhi Journal of Ophthalmology, Dr R.P.Centre, AIIMS.


Corresponding Author:

Siddharth Madan (MS, DNB, FICO)
Department of Ophthalmology, 
Lady Hardinge Medical College and Associated Hospitals, University Of Delhi, 
Shaheed Bhagat Singh Marg, Connaught place, New Delhi - 110001, India
Email id: drsiddharthmadan@gmail.com


Received: 16-OCT-2019 Accepted: 16-NOV-2019 Published Online: 09-MAY-2020
DOI: https://dx.doi.org/10.7869/djo.522

Abstract
Purpose: We analysed the effect of primary laser ablation and primary intravitreal ranibizumab (IVR) therapy administered alone or followed by peripheral laser ablation for the treatment of type I ROP and Aggressive Posterior ROP (APROP). 
Methods: Sixty eight eyes of 35 babies treated for ROP were analysed from September 2016 to March 2019. 14 eyes of seven babies underwent primary laser treatment. Primary IVR was given in 54 eyes of 28 babies. 
Results: Nine of 14 (64.28%) eyes recovered with laser treatment and five progressed to stage IV or V ROP which did not recover even with surgical intervention. 44 of 54 (81.48%) eyes recovered fully after single dose of IVR by ten weeks and remaining ten eyes underwent laser of the avascular area after two to ten weeks following IVR therapy. Six of these ten eyes recovered fully while four progressed and underwent surgery for stage IV or V. Three of these four operated cases had attached retina after surgery. Hence 50 of 54 eyes (92.59%) eyes who underwent primary IVR therapy or with subsequent laser recovered while only four of the nine eyes (64.28%) recovered with primary laser treatment. No progression, reactivation and systemic complications were observed over an average follow-up of six months in babies who received primary IVR alone or with subsequent management. 
Conclusions: IVR or IVR followed by laser by ten weeks following injection is a safe and efficacious primary treatment for ROP with gratifying results in type I disease or APROP.

Keywords :Intravitreal ranibizumab for Retinopathy of prematurity, IVR followed by laser for ROP