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

Wenting Zhang; Huanyu Liu; Yiye Chen; Xuerui Zhang; Victoria Y. Gu; Haodong Xiao; Yuan Yang; Jiawei Yin; Jie Peng; Peiquan Zhao

doi:10.1001/jamaophthalmol.2023.6198

Comment

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Original Investigation

January 18, 2024

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

奥别苍迟颈苍驳听窜丑补苍驳,听惭顿¹; 贬耻补苍测耻听尝颈耻,听惭顿¹; 驰颈测别听颁丑别苍,听惭顿¹; et al 齿耻别谤耻颈听窜丑补苍驳,听惭顿¹; Victoria Y.听Gu,听MSPH²; 贬补辞诲辞苍驳听齿颈补辞,听惭顿¹; 驰耻补苍听驰补苍驳,听惭顿¹; 闯颈补飞别颈听驰颈苍,听惭惭¹; 闯颈别听笔别苍驳,听惭顿¹; Peiquan听Zhao,听MD, PhD¹

Author Affiliations Article Information

¹Department of Ophthalmology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
²Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

JAMA Ophthalmol. 2024;142(2):133-139. doi:10.1001/jamaophthalmol.2023.6198

Key Points

Question听 What are the outcomes and safety associated with intra-anterior chamber injection with ranibizumab in treating advanced pediatric vitreoretinal diseases with vascular endothelial growth factor鈥搑elated vascular abnormalities?

Findings听 In this case series study that included 14 eyes of 13 children, vascular activity decreased in 14 of 14 eyes during the 1-month postoperative follow-up and was no longer apparent in 7 of 14 eyes during the 3-month follow-up. No complications were reported.

Meaning听 These preliminary results in a small number of eyes support the potentially relatively safe use of intra-anterior chamber injection of ranibizumab in advanced pediatric vitreoretinal diseases.

Abstract

Importance听 Anti鈥搗ascular 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听 To investigate the effects and safety of IAcI of anti-VEGF to treat VEGF-driven pediatric vitreoretinal diseases.

Design, Setting, and Participants听 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听 IAcI with ranibizumab.

Main Outcomes and Measures听 Retinal vascular abnormalities, vitreous hemorrhage resolution, and complications 1 month and 3 months after injection.

Results听 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听 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.

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