Anterior Chamber Ranibizumab Injections May Benefit Pediatric Vitreoretinal Diseases

Peiquan Zhao, MD, PhD

Credit: American Society of Retina Specialists

A new case series provides insight into the outcomes and safety associated with intra-anterior chamber injection of ranibizumab for treating advanced pediatric vitreoretinal diseases with vascular endothelial growth factor (VEGF)-related vascular abnormalities.¹

These preliminary data on a small number of eyes indicate vascular activity decreased in all study eyes during the 1-month postoperative follow-up and was no longer observed in half of the eyes during the 3-month follow-up, with intra-anterior chamber injection of ranibizumab.

“These findings, while limited by biases associated with retrospective designs and relatively small number of eyes, suggest potential promise that intra-anterior chamber injection with anti-VEGF agents might be an effective primary treatment to reduce these retinal vascular abnormalities in the short term,” wrote the investigative team, led by Jie Peng, MD and Peiquan Zhao, MD, PhD, department of ophthalmology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine.

Anti-VEGF therapy has shown therapeutic efficacy as a primary and adjunct treatment for multiple VEGF-driven pediatric vitreoretinal diseases. The most common delivery method is an intravitreal injection, while a subretinal injection can offer efficacy for cases including retinal detachments.² As these methods can often prove difficult, Zhao and colleagues indicated the viability of an anti-VEGF drug delivery method via the anterior chamber.¹

The retrospective intervention case series was performed at the investigator’s institution in China. Primary outcomes for the study consisted of vascular activity regression or vitreous hemorrhage resolution at the 1-month and 3-month mark post-injection of ranibizumab. Zhao and colleagues defined vascular activity regression as the regression of neovascularization, venous dilation, and arteriolar tortuosity within the retina.

Investigators ceased the evaluation if intraocular surgery was required or on the occurrence of media opacity. Investigators also evaluated outcomes of endophthalmitis, increased proliferation, cornea clarity, new vitreous hemorrhage, and intraocular pressure at the 1-month and 3-month marks post-injection.

Overall, the study reviewed 14 eyes of 13 children referred with clinical manifestations of elevated vascular activity between January and August 2023 in the analysis. Participants had a mean age of 4.6 years, while 12 of 13 children were male. In the population, 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 origin.

Vitrectomy preceded intra-anterior chamber injection of ranibizumab in 10 eyes, while elevated IOP was detected in 3 patients and required aqueous humor drainage. At the 1-month postoperative mark, investigators observed a vascular activity decrease in all 14 eyes. By the 3-month follow-up, they found vascular activity had resolved in 7 eyes, persisted in 6 eyes, and reactivated in 1 eye.

No indication of complications, including endophthalmitis and cornea clarity, were reported on final observation in the study. Zhao and colleagues noted these data support the use of intra-anterior chamber injection of ranibizumab for advanced pediatric vitreoretinal diseases, but further research is needed to understand its exact benefit-risk profile.

“This approach might be considered in cases where intravitreal or subretinal injection is not feasible, recognizing the limitations of these findings and that longer-term outcomes still need to be monitored,” investigators wrote.

References

1. _{Zhang W, Liu H, Chen Y, et al. Intra-Anterior Chamber Injection of Ranibizumab in Advanced Pediatric Vitreoretinal Diseases. JAMA Ophthalmol. Published online January 18, 2024. doi:10.1001/jamaophthalmol.2023.6198}
2. _{Peng J, Liang T, Chen C, et al. Subretinal injection of ranibizumab in advanced pediatric vasoproliferative disorders with total retinal detachments. Graefes Arch Clin Exp Ophthalmol. 2020;258(5):1005-1012. doi:10.1007/s00417-020-04600-3}