Intra-anterior chamber anti-VEGF injections feasible treatment for advanced paediatric vitreoretinal diseases

Evaluating injections of anti-VEGF drugs into the intra-anterior chamber may be a viable alternative for paediatric patients. Image credit: ©famveldman – stock.adobe.com

A team of international investigators from Shanghai Jiao Tong University School of Medicine, Shanghai, China, and Johns Hopkins Bloomberg School of Public Health, Baltimore published a new study the results of which suggested that intra-anterior chamber injection of ranibizumab (Lucentis, Genentech), an anti-vascular endothelial growth factor (VEGF) therapy, is a potentially relatively safe treatment for advanced paediatric vitreoretinal diseases.¹

Treating paediatric patients with intravitreal or subretinal anti-VEGF injections is effective for vitreoretinal diseases that are driven by VEGF; however, that approach does not work for patients with advanced diseases that include shallow traction retinal detachments or peripheral circumferential retinal detachments that adhere to the lens, the authors pointed out.

Evaluating injections of anti-VEGF drugs into the intra-anterior chamber may be a viable alternative, but further study is required, according to first author Wenting Zhang, MD.

Dr Zhang and colleagues conducted a retrospective observational case series study between January and August 2023 at Xinhua Hospital, Shanghai, that included 13 children (12 boys, 1 girl; 14 eyes; mean age, 4.6 years; range, 1 month-9 years) with vitreoretinal diseases with elevated vascular activity. The children had been diagnosed with the following disorders: 6 with familial exudative vitreoretinopathy, 4 with morning glory syndrome, 1 with retinopathy of prematurity and 2 with chronic retinal detachments of unknown causes.

The children were treated with intra-anterior chamber injections of ranibizumab. The main outcome measures were retinal vascular abnormalities, resolution of vitreous hemorrhage and complications at 1 and 3 months after injection.

The investigators reported that 1 month after treatment, the vascular activity decreased in all 14 eyes. By the 3-month evaluation of the 14 eyes, the vascular activity had resolved in 7 eyes, persisted in 6 eyes and reactivated in 1 eye. At the final evaluation, no complications associated with treatment were observed.

These preliminary findings, according to the authors, support the possibility of treatment using intra-anterior chamber injections with ranibizumab to decrease retinal vascular abnormalities in familial exudative vitreoretinopathy or retinopathy of prematurity or related conditions.

However, they advised that further studies should be conducted to understand more precisely the benefits and risks.

“This approach might be considered in cases in which intravitreal or subretinal injections are not feasible, recognising the limitations of these findings and that longer term outcomes still need to be monitored. These preliminary results in a small number of eyes support the potentially relatively safe use of intra-anterior chamber injection of ranibizumab in advanced paediatric vitreoretinal diseases,” they concluded.

Reference

1. Zhang W, Liu H, Chen Y, et al. Intra-anterior chamber injection of ranibizumab in advanced pediatric vitreoretinal diseases. JAMA Ophthalmol. 2024; published online January 18, 2024; doi:10.1001/jamaophthalmol.2023.6198