Combined intravitreal bevacizumab injection and zone I sparing laser photocoagulation in patients with zone I retinopathy of prematurity.

PURPOSE To investigate the anatomical outcome of combined intravitreal bevacizumab injection and Zone I sparing laser ablation in patients with Type 1 retinopathy of prematurity in Zone I. METHODS The medical records of consecutive 18 eyes of 10 infants, who underwent combined intravitreal bevacizumab (0.25 mg) injection and Zone I sparing laser ablation for the treatment of Type 1 retinopathy of prematurity in Zone I, were retrospectively reviewed. Laser photocoagulation was performed on the avascular retina anterior to the margin of Zone I extending to the ora serrata. Anatomical outcomes including progression to stage 4/5, macular changes, and vitreous organization were reviewed. RESULTS The mean gestational age at birth and the birth weight of included patients were 24.0 weeks and 628 g, respectively. The timing of bevacizumab injection ranged from postmenstrual age 33(+2) to 35 weeks (mean, 34.3 weeks). Postmenstrual age at last follow-up ranged from 74(+6) to 107(+1) weeks (mean, 83.6 weeks). All 18 eyes demonstrated prompt regression of neovascular pathology and plus disease without recurrence. Previously avascular Zone I retina was vascularized in all eyes after the treatment. All eyes showed excellent anatomical outcome with intact macula, but one eye showed mild vitreous organization above the vascular/avascular junction. CONCLUSION Combined intravitreal bevacizumab injection and Zone I sparing laser ablation for Type 1 retinopathy of prematurity in Zone I seem to be effective treatment options. Possible advantages include lower dose of anti-vascular endothelial growth factor, less recurrence than monotherapy, and preservation of central visual field.