Recurrence of Retinopathy of Prematurity After Intravitreal Aflibercept: A Retrospective Analysis

khosro sanyar tato

khosro sanyar tato College of Medicine-University of Duhok, Kurdistan Region of Iraq

Keywords: R.O.P – Retinopathy of Prematurity, VEGF – Vascular Endothelial Growth Factor, PlGF – Placental Growth Factor, PRP – Panretinal Photocoagulation, FDA – Food and Drug Administration, SPSS – Statistical Package for the Social Sciences, ICROP – International Classification of Retinopathy of Prematurity

Abstract

https://doi.org/10.31386/dmj.2025.19.1.7

Background: Retinopathy of Prematurity (R.O.P) is a primary cause of blindness in premature babies with abnormal retinal vasculature. Anti-VEGF agents, such as Aflibercept (Eylea), have also emerged as a treatment option for severe R.O.P instead of laser photocoagulation..

Aim of the study: This study was conducted to evaluate the rate of recurrence of R.O.P following intravitreal Aflibercept injections in premature infants and the outcomes of re-treatment, including laser therapy.

Methods : A retrospective cohort study was conducted at Duhok Eye Hospital from 2019 to 2024. Participants included neonates treated with intravitreal Aflibercept injections for Type 1 R.O.P. Recurrent lesions were managed with additional Aflibercept injections, or in cases of peripheral recurrence, with laser therapy.

Results: A total of 122 eyes from preterm infants were treated with Aflibercept. R.O.P recurred in 51.6% of cases (63 eyes), with higher recurrence rates in Zone 2 (58.8%) compared to Zone 1 (15%) (p = 0.003). All Zone 1 recurrences were successfully treated with additional Aflibercept injections. For Zone 2 recurrences, laser therapy was used, with 20% of cases requiring a second session. Complete retinal vascularization was achieved in 43.4% of eyes by 65 weeks postmenstrual age. No cases of endophthalmitis or vitreous hemorrhage were observed.

Conclusion: Aflibercept is an effective and safe treatment for Type 1 R.O.P, particularly in Zone 1. However, the higher rate of recurrence in Zone 2 mandates close follow-up and the potential role of adjunctive laser therapy.

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