{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:38:16Z","timestamp":1792791496613,"version":"4.5.0"},"reference-count":107,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2025,8,12]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>Anti-vascular endothelial growth factor (anti-VEGF) agents have demonstrated efficacy and short-term safety in the treatment of retinopathy of prematurity (ROP), establishing them as the preferred option for zone I and zone II posterior disease. Despite their advantages, the effects of anti-VEGF agents are relatively temporary. Consequently, ROP may reactivate or recur if retinal vascularisation has not sufficiently progressed and significant areas of avascular anterior retina remain while the anti-VEGF agents are cleared from the vitreous cavity. Extreme prematurity, early onset of ROP and severe disease at baseline (aggressive ROP or zone I disease) significantly increase this risk.<\/jats:p>\n                  <jats:p>Reactivated ROP presents differently from initial ROP presentation and may be subtle on clinical examination; however, it can often be detected earlier with fluorescein angiography. The interval and rates of reactivation vary depending on the type and dose of anti-VEGF agents, with occurrences sometimes delayed for years after an initial quiescent period. This necessitates close follow-up after anti-VEGF monotherapy until retinal vascularisation is complete or laser treatment is administered to the persistent peripheral avascular retina.<\/jats:p>\n                  <jats:p>On reactivation, the condition may be managed with repeat injections or laser treatment. Repeated anti-VEGF injections pose risks, including vascular arrest, persistent avascular retina, endophthalmitis and systemic toxicity. Late-detected reactivations or cases unresponsive to initial treatments may require vitrectomy. Generally, retreatment leads to disease regression with favourable structural outcomes. Currently, longer-acting drugs and prophylactic laser treatment of the avascular anterior retina are the only supported strategies for reducing reactivation.<\/jats:p>","DOI":"10.1136\/bjo-2025-327597","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T07:50:13Z","timestamp":1756713013000},"page":"117-124","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Reactivation of retinopathy of prematurity after anti-VEGF treatment: a review"],"prefix":"10.1136","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0204-7024","authenticated-orcid":false,"given":"Devesh","family":"Kumawat","sequence":"first","affiliation":[{"name":"Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, 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