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A 13 months old female baby born at 24 weeks of gestational age (GA) presented with stage 4A retinopathy of prematurity (ROP) with plus disease in the right eye and stage 3 with plus disease in the left eye. The baby was diagnosed with stage 3 zone 2 ROP in both eyes with plus disease at 32 weeks of GA and received intravitreal bevacizumab in both eyes. The baby received intravitreal bevacizumab and ranibizumab injections at 39 and 57 weeks of postmenstrual age (PMA), respectively for recurrence. Laser treatment to peripheral avascular retina was carried out at 67 weeks of PMA. The right eye progressed to stage 4A and left eye developed pre-retinal haemorrhages. This case reports late recurrence treated with initial multiple antivascular endothelial growth factor (VEGF) injections alone. One should be cautious in using anti-VEGF agents as a monotherapy in cases of ROP that appear different from the current understanding of the natural course of the disease.

Smouldering retinopathy of prematurity: a case treated by multiple antivascular endothelial growth factor therapy