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Case report
Contralateral effect of systemic absorption of low dose bevacizumab (Avastin) after unilateral intravitreal injection in severe retinopathy of prematurity (ROP)
  1. Ayad Shafiq1,
  2. Roxane Hillier1 and
  3. Richard Hearn2
  1. 1Ophthalmology, Royal Victoria Infirmary, Newcastle, UK
  2. 2Royal Victoria Infirmary, Newcastle upon Tyne, Newcastle upon Tyne, UK
  1. Correspondence to Ayad Shafiq; ayad.shafiq{at}


An extremely premature baby boy born at 23 weeks’ gestational age was treated with unilateral low dose of 0.16 mg/0.025 mL intravitreal bevacizumab in the left eye for aggressive retinopathy of prematurity (ROP). He developed photographically documented changes in his contralateral right eye on imaging 5 days later. Second eye treatment was at 12 days. He has development assessment and ophthalmic review beyond age 2, which is normal. Systemic absorption of the drug caused an end organ effect to slow down and reverse ROP in his untreated right eye. Both eyes vascularised fully. His normal Bayley III developmental score at age 2 is uncommon for a 23-week gestation baby. Even at a low dose, bevacizumab has the potential for end organ effect on the second eye, and therefore other organs. In this case, there are no medium-term measurable neurodevelopmental side-effects. We suggest longer term follow-up is required before excluding unwanted side-effects.

  • unwanted effects / adverse reactions
  • neonatal and paediatric intensive care
  • retina
  • eye

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  • Contributors AS is the main author of the article and has the largest contribution to its writing. He treated the baby described in the case report. RoH's contribution includes treating the child described as well as AS and interpreting the signs reported and their significance with AS. She has made amendments to the drafts of the article. RiH performed the development assessments described and interpreted their significance for the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.