Clinical Features and Outcomes of Infants with Retinopathy of Prematurity Who Fail Anti-VEGF Therapy.

Purpose To describe characteristics and outcomes of patients with retinopathy of prematurity (ROP) who failed intravitreal anti-VEGF. Methods A retrospective case series of 211 eyes (112 patients) treated with anti-VEGF as initial therapy for ROP at a single academic institution between 2011-2019, and an additional 6 eyes (3 patients) referred to us for management of failed anti-VEGF. Results Among 211 eyes receiving initial treatment at our institution, 17 (11%) failed. Of the 23 total eyes managed by us for failure, 3 (13%) failed after 50 weeks post-menstrual age (PMA). Failure manifested as recurrent plus in 14 (58%), recurrent stage 3 in 13 (54%) and retinal detachment in 5 eyes (21%). Treatment failures were managed with laser (13 eyes), repeat injection (4 eyes), vitrectomy (2 eyes), or a combination of modalities (4 eyes). Follow-up of >6 months was available for 18 of 23 eyes. The retina was fully attached in 17 and fixation behavior was present in 10 eyes. Conclusion The most common manifestations of treatment failure were recurrent plus and stage 3. The failure rate at our institution was 11.0%. A significant proportion of failures occurred after 50 weeks PMA. Most failed eyes had favorable anatomic outcomes and over half demonstrated fixation behavior.