# Occult retinal neovascularization following intravitreal bevacizumab and laser treatment for retinopathy of prematurity

## TL;DR

A premature infant with ROP showed worsening eye condition after treatment, but FFA revealed hidden blood vessel growth, leading to additional treatment.

## Contribution

Demonstrates the utility of FFA in detecting occult neovascularization after ROP treatment regression.

## Key findings

- Worsening plus disease occurred despite complete regression of stage 3 ROP.
- FFA identified occult neovascularization not visible through standard exams.
- Additional treatment improved the condition but mild arteriolar tortuosity remained.

## Abstract

We present a patient with retinopathy of prematurity (ROP) who developed worsening plus disease after complete regression of stage 3 ROP. The use of fundus fluorescein angiography (FFA) aided the visualization of occult neovascularization that caused the disease progression.

The patient was at high risk for ROP due to low birth weight of 690 g and gestational age of 25 weeks. After the diagnosis of stage 3 ROP in zone I without plus disease, she was treated initially with bilateral intravitreal bevacizumab (IVB) and followed by laser photocoagulation 5 weeks later. Despite the resolution of ROP stage, the plus disease worsened. Neither systemic risk factors nor skip laser areas were observed. Hence, FFA was performed and subsequently identified occult neovascularization with active leakage. Additional IVB and laser treatment in the capillary dropout area inside vascularized retina were added. The plus disease improved but mild arteriolar tortuosity persisted.

Worsening of plus disease after completion of laser ablation and IVB with complete regression of stage 3 ROP is rare. Systemic risk factors such as continuous oxygen therapy and cardiovascular disease should be ruled out. FFA aided in identifying occult neovascularization and prompted further treatment.