Intra-Anterior Chamber Injection of Ranibizumab in Advanced Pediatric Vitreoretinal Diseases.

Importance: Anti-vascular endothelial growth factor (VEGF) treatment through intravitreal or subretinal administrations has been proven effective for VEGF-driven pediatric vitreoretinal diseases but are not feasible for advanced cases, such as shallow traction retinal detachments or peripheral circumferential retinal detachments which adhere to the lens. Intra-anterior chamber injection (IAcI) of anti-VEGF may be a viable alternative in such cases but needs evaluation. Objective: To investigate the effects and safety of IAcI of anti-VEGF to treat VEGF-driven pediatric vitreoretinal diseases. Design, Setting, and Participants: This was a retrospective observational case series study conducted at Xinhua Hospital, affiliated with Shanghai Jiao Tong University School of Medicine in China. The study included 14 eyes of 13 children diagnosed with vitreoretinal disease exhibiting elevated vascular activity between January and August 2023. Intervention: IAcI with ranibizumab. Main Outcomes and Measures: Retinal vascular abnormalities, vitreous hemorrhage resolution, and complications 1 month and 3 months after injection. Results: Of 13 patients included in this study, 12 were male. The mean age was 4.6 years (range, 1 month to 9 years). Six patients were diagnosed with familial exudative vitreoretinopathy, 4 with morning glory syndrome, 1 with retinopathy of prematurity, and 2 with chronic retinal detachments of unknown causes. At 1-month postoperative follow-up, vascular activity had decreased in 14 of 14 eyes. At 3-month follow-up, vascular activity had resolved in 7 of 14 eyes, persisted in 6 of 14 eyes, and reactivated in 1 of 14 eyes. On final observation, no complications were reported. Conclusions and Relevance: These findings support the possibility of treatment using IAcI with ranibizumab to decrease retinal vascular abnormalities in familial exudative vitreoretinopathy or retinopathy of prematurity or related conditions, but further studies are needed to understand more precise benefits and risks. This approach might be considered in cases where intravitreal or subretinal injection are not feasible, recognizing the limitations of these findings and that longer-term outcomes still need to be monitored.

INTRAVITREAL RANIBIZUMAB TREATMENT FOR ADVANCED FAMILIAL EXUDATIVE VITREORETINOPATHY WITH HIGH VASCULAR ACTIVITY.

PURPOSE: To determine the efficacy of intravitreal ranibizumab (IVR) treatment for advanced familial exudative vitreoretinopathy with high vascular activity. METHODS: The retrospective interventional case series included 28 eyes (20 patients) that had IVR in combination or not with other treatment, for Stage 3 to 5 familial exudative vitreoretinopathy with active fibrovascular proliferation and prominent subretinal exudation. Outcome measures were fundus features after treatment, associated clinical variables, and genetic mutations. RESULTS: The age of patients at the first IVR ranged from 0.2 to 36 months. An average of 1.3 IVR injections per eye were given. Familial exudative vitreoretinopathy regressed in 16 (57%) eyes and progressed in 12 eyes (43%) after IVR. Laser and/or vitrectomy was performed on 13 eyes. The retina was reattached in 22 eyes (78%) after 24 to 58 months follow-up. Clinical variables associated with progression after IVR were preexisting fibrovascular proliferation over one quadrant and persistent vascular activity after the initial injection (P < 0.05). Familial exudative vitreoretinopathy-causative genetic mutations in 11 patients were related to variable response to IVR treatment. CONCLUSION: Intravitreal ranibizumab treatment may effectively regress advanced familial exudative vitreoretinopathy with high vascular activity in selected cases. Different treatment outcomes may be relevant to variable presentation and genetic heterogeneity of familial exudative vitreoretinopathy.

Subretinal injection of ranibizumab in advanced pediatric vasoproliferative disorders with total retinal detachments.

PURPOSE: To describe the surgical procedures, outcomes, and complications of a novel technique of subretinal injection of ranibizumab (SRR). METHODS: Between September 2012 and September 2018, 37 eyes of 26 consecutive children with vascularly active total retinal detachments in 1 or both eyes treated with SRR as primary treatment were included in this retrospective study. All included eyes received subretinal injection of ranibizumab (0.25 mg/ 0.025 ml). Data included demographics, ocular examination, and anatomic outcomes, following treatment and complications of eyes after SRR were collected. RESULTS: Eleven patients had bilateral SRR injections and 15 had monocular SRR injection. Thirteen patients were diagnosed as retinopathy of prematurity. Of all patients, the mean gestational age was 34.5 ± 5.1 weeks (range: 29.6~40.7 weeks), and birth weight was 2328.1 ± 1083.9 g (range: 940~3900 g). On 1-week postoperative follow-up, vascular activity decreased in all 37 eyes (100%). On the 1-month postoperative follow-up, vascular activity decreased but remained in 24 eyes (24/35, 68.6%) of 16 patients and vanished in 11 eyes (11/35, 31.4%) of 9 patients. No eye needed a secondary anti-VEGF therapy. Local subconjunctival hemorrhage was noted in two eyes (2/37, 5.4%). Localized wound leakage of subretinal fluid was also noted in one eye (1/37, 2.7%). CONCLUSIONS: In this very limited study, we showed that SRR in vascularly active advanced pediatric vasoproliferative disorders with total retinal detachments is effective and promising, although more extensive controlled trials will be needed to confirm its safety and efficacy.