Subretinal injection of ranibizumab in advanced pediatric vasoproliferative disorders with total retinal detachments.

Purpose: To describe the surgical procedures, outcomes, and complications of a novel technique of subretinal injection of ranibizumab (SRR).

Methods: Between September 2012 and September 2018, 37 eyes of 26 consecutive children with vascularly active total retinal detachments in 1 or both eyes treated with SRR as primary treatment were included in this retrospective study. All included eyes received subretinal injection of ranibizumab (0.25 mg/ 0.025 ml). Data included demographics, ocular examination, and anatomic outcomes, following treatment and complications of eyes after SRR were collected.

Results: Eleven patients had bilateral SRR injections and 15 had monocular SRR injection. Thirteen patients were diagnosed as retinopathy of prematurity. Of all patients, the mean gestational age was 34.5 ± 5.1 weeks (range: 29.6~40.7 weeks), and birth weight was 2328.1 ± 1083.9 g (range: 940~3900 g). On 1-week postoperative follow-up, vascular activity decreased in all 37 eyes (100%). On the 1-month postoperative follow-up, vascular activity decreased but remained in 24 eyes (24/35, 68.6%) of 16 patients and vanished in 11 eyes (11/35, 31.4%) of 9 patients. No eye needed a secondary anti-VEGF therapy. Local subconjunctival hemorrhage was noted in two eyes (2/37, 5.4%). Localized wound leakage of subretinal fluid was also noted in one eye (1/37, 2.7%).

Conclusions: In this very limited study, we showed that SRR in vascularly active advanced pediatric vasoproliferative disorders with total retinal detachments is effective and promising, although more extensive controlled trials will be needed to confirm its safety and efficacy.