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Raghuveer TS, Zackula RE, Hartnett ME. Aflibercept to treat retinopathy of prematurity: need for more research. J Perinatol 2024:10.1038/s41372-024-01997-1. [PMID: 38730278 DOI: 10.1038/s41372-024-01997-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
Until recently, the standard care for retinopathy of prematurity (ROP) was destructive treatment of the peripheral avascular retina, most often using laser therapy. Now, intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents have been included in recommendations for treatment-warranted ROP. The three anti-VEGF agents used to treat ROP are bevacizumab, ranibizumab, and aflibercept and clinical trials using, a variety of treatment strategies, have shown all three are efficacious and easy to administer. Intravitreal Bevacizumab is most used in the US, and ranibizumab has been approved for ROP use in Europe. In 2023, the FDA approved aflibercept for treatment of severe ROP. We summarize the clinical trial results and provide a side-by-side comparisons of the three drugs. Despite FDA approval of the use of aflibercept to treat ROP, there is a need for more research as the body of knowledge regarding this agent to treat ROP is limited.
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Affiliation(s)
- Talkad S Raghuveer
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, KS, USA.
| | - R E Zackula
- Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - M E Hartnett
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
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Huang YC, Hsu KH, Chu SM, Chiang MC, Lien R, Chen KJ, Hwang YS, Lai CC, Tseng HJ, Wu WC. Respiratory outcomes in preterm infants following intravitreal bevacizumab for retinopathy of prematurity-a 10-year matched case study. Eye (Lond) 2023; 37:3675-3681. [PMID: 37400566 PMCID: PMC10686401 DOI: 10.1038/s41433-023-02579-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/05/2023] [Accepted: 05/11/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES To evaluate respiratory outcomes in preterm infants with retinopathy of prematurity (ROP) following intravitreal bevacizumab injection (IVB). METHODS This single-centre study enroled preterm infants with a gestational age (GA) < 34 weeks or a birth weight (BW) < 1500 g with bilateral type 1 ROP who received a single IVB, and a treatment-free control group matched by GA, postmenstrual age, and respiratory status at the time of the IVB. The primary outcome was serial respiratory changes in mean airway pressure (MAP), fraction of inspired oxygen (FiO2), and respiratory severity score (RSS, MAP x FiO2) during the 28-day post-IVB/matching period and overall respiratory improvement at day 28 and at discharge. The duration of supplemental oxygen therapy following IVB/matching was documented. RESULTS A total of 5578 infants were included. Seventy-eight infants were enroled in the IVB group, and another 78 infants were matched as the control group. Both groups had downward trends in the MAP, FiO2, and RSS over the study period (all P < 0.001), but there were no between-group differences in these measures. The percentage of overall respiratory improvement was similar between the IVB and control groups, so was the duration of invasive and in-hospital oxygen ventilation. A lower percentage of oxygen dependence at discharge in the IVB group (P = 0.03) remained significant after adjusting for GA and BW. CONCLUSIONS This is a matched case study to evaluate respiratory outcomes in preterm infants following IVB for ROP. We found that the IVBs did not compromise respiratory outcomes in preterm infants during the 28-day post-IVB period and at discharge.
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Affiliation(s)
- Ying-Chen Huang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kai-Hsiang Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Chu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Reyin Lien
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Hsiao-Jung Tseng
- Biostatistics unit, Clinical Trial Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Baysal SG, Ekinci DY, Okur N. Neurodevelopment of patients who received intravitreal bevacizumab or aflibercept for type 1 and aggressive retinopathy of prematurity. Eur J Ophthalmol 2023; 33:2243-2249. [PMID: 37680054 DOI: 10.1177/11206721231200666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE We aimed to compare the neurodevelopment of patients who received intravitreal bevacizumab (IVB) and intravitreal aflibercept (IVA) for type 1 retinopathy of prematurity (ROP) and aggressive ROP (A-ROP) using the Ages and Stages Questionnaire (ASQ-3) test. METHODS Patients who underwent IVB (group 1), IVA (group 2), and patients who did not receive treatment (group 3) were included in the prospective-controlled study. The patients were grouped as low-intermediate-high risk according to the high-risk infant follow-up guide. With the ASQ-3 test, fine and gross motor movements, communication, problem solving, and personal-social developments of the patients were compared. RESULTS The gender distribution, birth weight (BW), and neonatal risk category of the groups were similar. Gestational age (GA) of group 1 was found to be lower compared to group 3. There was no difference between the groups in the development of gross and fine motor movements, communication and problem solving. The personal and social development of group 1 and group 2 was found to be retarded compared to the control group. DISCUSSION As a result, the detection of retardation in the personal and social areas in the treated patients, and the detection of retardation in other areas, although not significant, reveals the necessity of following the development of these patient groups and providing the necessary support in the areas where retardation is detected.
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Affiliation(s)
- Senay Guven Baysal
- Gazi Yasargil Research and Training Hospital, University of Health Sciences, Department of Developmental Pediatrics, Diyarbakir, Turkey
| | - Dilbade Yildiz Ekinci
- Gazi Yasargil Research and Training Hospital, University of Health Sciences, Department of Ophtalmology, Diyarbakir, Turkey
| | - Nilufer Okur
- Gazi Yasargil Research and Training Hospital, University of Health Sciences, Department of Neonatology, Diyarbakir, Turkey
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Huang CY, Lai SH, Tseng HJ, Yao TC, Wu WC. Pulmonary function in school-age children following intravitreal injection of bevacizumab for retinopathy of prematurity. Sci Rep 2022; 12:18788. [PMID: 36335152 PMCID: PMC9637204 DOI: 10.1038/s41598-022-22338-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
The effect of anti-vascular endothelial growth factor on neonatal lung development was inconclusive. To evaluate pulmonary function in school-age children who have received intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP), this study included 118 school-aged children who were grouped into three groups: full-term control children (group 1), preterm children who had not received IVB treatment (group 2) and preterm children with ROP who had received IVB treatment (group 3). Pulmonary function was measured by spirometry and impulse oscillometry. Pulmonary function was significantly better in group 1 than in groups 2 and 3 (all p < 0.05 in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow between 25 and 75% of FVC (FEF25-75), and respiratory resistance at 5 Hz and difference between respiratory resistance at 5 and 20 Hz (R5-R20). There were no statistically significant differences between group 2 and group 3 in all pulmonary function parameters, including FVC, FEV1, ratio of FEV1 to FVC, FEF25-75, R5, R20, R5-R20, and respiratory reactance at 5 Hz. In conclusion, our study revealed that preterm infants receiving IVB for ROP had comparable pulmonary function at school age to their preterm peers who had not received IVB treatment.
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Affiliation(s)
- Ching-Yen Huang
- grid.413801.f0000 0001 0711 0593Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan, 33305 Taiwan
| | - Shen-Hao Lai
- grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.413801.f0000 0001 0711 0593Division of Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiao-Jung Tseng
- grid.413801.f0000 0001 0711 0593Clinical Trial Center, Biostatistics Unit, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Chieh Yao
- grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.413801.f0000 0001 0711 0593Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Gueishan, Taoyuan, 33305 Taiwan
| | - Wei-Chi Wu
- grid.413801.f0000 0001 0711 0593Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan, 33305 Taiwan ,grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Evaluation of Neurodevelopmental Outcomes in Premature Twins (Multigestations) with Retinopathy of Prematurity Receiving Anti-VEGF: A Comparison Study. J Ophthalmol 2022; 2022:5177401. [PMID: 35957746 PMCID: PMC9357713 DOI: 10.1155/2022/5177401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess possible neurodevelopmental delay (NDD) following intravitreal antivascular endothelial growth factor (VEGF) injection in neonates with retinopathy of prematurity (ROP). Methods In this retrospective cohort study, neurodevelopmental milestones in patients with a history of ROP and intravitreal bevacizumab (IVB) injection were compared with other gestations that received either no treatment or only a laser for treatment. Results One hundred and twenty-five neonates (of 59 multi-gestation pregnancies) were included in this study (with the range of age 1–7 years old). Sixty-five (51.18%) were male and sixty-two (48.81%) were female. The mean gestational age (GA) and birth weight of all neonates were 29.69 ± 1.57 weeks (ranges: 26–33 weeks) and 1312.50 ± 269.33 grs (ranges: 730–2100 grs). None of the neurodevelopmental outcomes were statistically different when two subgroups in group A (IVB vs. control) were compared. None of the differences between IVB and laser treated subgroups is statistically significant, except for “reaching for toys,” which was delayed in the laser treated subgroup (6.6 ± 2.5 and 6.9 ± 2.5 months in IVB and laser treated subgroups, respectively). Conclusion In neonates with ROP, there is no linear correlation between intravitreal anti-VEGF injection and neurodevelopmental delay.
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Beccasio A, Mignini C, Caricato A, Iaccheri B, Di Cara G, Verrotti A, Cagini C. New trends in intravitreal anti-VEGF therapy for ROP. Eur J Ophthalmol 2022; 32:1340-1351. [PMID: 35040348 DOI: 10.1177/11206721211073405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Retinopathy of Prematurity (ROP) affects premature newborns, and it can cause childhood blindness and visual impairment if untreated. The understanding of the pathogenetic role of Vascular Endothelial Growth Factor (VEGF) has led to development of therapeutic strategies such as intravitreal anti-VEGF drugs. We reported drug efficacy and ROP recurrence rates, extrapolated from the reviewed studies. Association of Pegabtanib and laser photocoagulation confers efficacy in the regression of ROP stage 3 plus in zone I / II in 89.7% of treated eyes, reducing the recurrence rate to 14.6% compared to 50% of laser therapy alone. Irrespective of the dose, Ranibizumab demonstrated average efficacy greater than 75% on regression of active disease with the highest rates of the dose of 0.1 mg (92.5%). The recurrence, on the other hand, is the highest among this new anti-VEGF agents and is around an average of 41.5%, which records the highest values in the case of Aggressive Posterior Rop (APROP). Aflibercept at a dose of 1 mg demonstrated average efficacy of about 81.9% of treated infants, analyzing significantly fewer studies than Ranibizumab. The recurrence rate stands at an average of 28.9%, especially in the later forms of ROP. Using a dose of 0.25 mg of Conbercept, the disease regression rate is currently on average 83%, with an average recurrence rate of 15.24%, the peak of which was observed in cases of ROP in zone I. Further studies are needed to prove safety at long term, because,at the moment, only short-term data are available.
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Affiliation(s)
- Alfredo Beccasio
- Department of Medicine and Surgery, Section of Ophthalmology, S. Maria della Misericordia Hospital, 60250University of Perugia, Perugia, Italy
| | - Costanza Mignini
- Pediatric Clinic, Department of Medicine and Surgery, 18633Università degli Studi di Perugia, Perugia, Italy
| | - Anna Caricato
- Department of Medicine and Surgery, Section of Ophthalmology, S. Maria della Misericordia Hospital, 60250University of Perugia, Perugia, Italy
| | - Barbara Iaccheri
- Department of Medicine and Surgery, Section of Ophthalmology, S. Maria della Misericordia Hospital, 60250University of Perugia, Perugia, Italy
| | - Giuseppe Di Cara
- Pediatric Clinic, Department of Medicine and Surgery, 18633Università degli Studi di Perugia, Perugia, Italy
| | - Alberto Verrotti
- Pediatric Clinic, Department of Medicine and Surgery, 18633Università degli Studi di Perugia, Perugia, Italy
| | - Carlo Cagini
- Department of Medicine and Surgery, Section of Ophthalmology, S. Maria della Misericordia Hospital, 60250University of Perugia, Perugia, Italy
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Chen J, Hao Q, Zhang J, Du Y, Chen H, Cheng X. Short-term effects of intravitreal anti-vascular endothelial growth factor agents on body weight and multiple systems after treatment for retinopathy of prematurity. Front Pediatr 2022; 10:1077137. [PMID: 36760690 PMCID: PMC9905794 DOI: 10.3389/fped.2022.1077137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/09/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This study's goal was to assess the short-term effect on body weight and multiple systems following intravitreal injections of ranibizumab and aflibercept for retinopathy of prematurity (ROP). METHODS We retrospectively assessed infants with ROP who received intravitreal anti-vascular endothelial growth factor agents (VEGF) treatment at our hospital. They were classified into 2 groups based on the drugs administered: the intravitreal ranibizumab (IVR) group and the intravitreal aflibercept (IVA) group. The body weight (BW) gains for the pre-treatment week, the 1st week after treatment, and the 2nd week after treatment were compared for each group. Additionally, other parameters such as blood pressure, heart rate, oxygen concentration, volume of milk and output of urine at four time points were also measured. We used repeated measurement analysis of variance analyzed these data. RESULTS In total, 95 preterm infants were recruited, including 51 cases in the IVR group and 44 cases in the IVA group. The BW gain for the 1st week after treatment was significantly lower than the pre-treatment week in each group (P < 0.05), while there was no decrease in weekly BW gain in the 2nd week after treatment compared with that pre-treatment week. Based on the comparison between groups, the BW gain in the IVR group was significantly higher than in the IVA group in the second post-treatment week. Repeated measurement analysis of variance showed that there were no significant differences in blood pressure, heart rate, oxygen concentration, volume of milk and output of urine in both groups over time. CONCLUSIONS IVR and IVA could have a short-term inhibitive effect on body weight gain in infants after treatment for ROP, whereas there is no significant impact on other systems.
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Affiliation(s)
- Jing Chen
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingfei Hao
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Zhang
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanna Du
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haoming Chen
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiuyong Cheng
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Tsai CY, Yeh PT, Tsao PN, Chung YCE, Chang YS, Lai TT. Neurodevelopmental Outcomes after Bevacizumab Treatment for Retinopathy of Prematurity: A Meta-analysis. Ophthalmology 2020; 128:877-888. [PMID: 33212122 DOI: 10.1016/j.ophtha.2020.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate neurodevelopmental outcomes after intravitreal bevacizumab (IVB) therapy in retinopathy of prematurity (ROP) infants compared with those not exposed to IVB. CLINICAL RELEVANCE The primary concern regarding IVB treatment of ROP is the potential systemic side effects, especially the risk of causing severe neurodevelopmental impairment (sNDI). Results regarding neurodevelopmental outcomes after IVB therapy are conflicting. METHODS We conducted a meta-analysis and searched PubMed, Embase, and Web of Science for related publications from inception through March 12, 2020. The eligibility criteria were as follows: comparative studies of ROP patients that (1) included IVB as a treatment arm, (2) included a control group without bevacizumab treatment, and (3) reported on at least 1 neurodevelopmental outcome, such as sNDI, Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III), composition scores, or cerebral palsy (CP). The primary outcome was sNDI, with the odds ratio (OR) calculated. Secondary outcomes were mean differences (MDs) for cognitive, language, and motor scores (Bayley III) and OR for CP. The quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation approach. RESULTS Eight studies, 6 including laser-controlled ROP infants and 2 including ROP infants not requiring treatment, were included. The weighted OR for sNDI in the IVB group was 1.39 (95% confidence interval [CI], 0.98-1.97). The weighted MDs were -1.92 (95% CI, -4.73 to 0.88), -1.32 (95% CI, -4.65 to 1.99), and -3.66 (95% CI, -6.79 to -0.54) for cognitive, language, and motor scores in Bayley III, respectively. The OR for CP was 1.20 (95% CI, 0.56-2.55). No differences were observed between the preset subgroups comprising laser-controlled ROP infants and ROP infants not requiring treatment. The current quality of evidence was rated as low (sNDI and all Bayley III scores) to very low (CP). CONCLUSIONS Risk of sNDI was not increased in ROP patients after IVB treatment. Bayley III scores were similar in the IVB and control groups, except for a minor difference in motor performance. These findings suggest that the risk of additional sNDI after IVB treatment is low. Randomized trials are warranted to provide a higher quality of evidence.
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Affiliation(s)
- Chia-Ying Tsai
- Department of Ophthalmology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Ting Yeh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Research Center for Developmental Biology & Regenerative Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Chu Ella Chung
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Yu-Shan Chang
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Enríquez AB, Avery RL, Baumal CR. Update on Anti-Vascular Endothelial Growth Factor Safety for Retinopathy of Prematurity. Asia Pac J Ophthalmol (Phila) 2020; 9:358-368. [PMID: 32694348 DOI: 10.1097/apo.0000000000000302] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a neovascular retinal disorder that occurs in infants born prematurely. Nowadays, ROP constitutes a leading cause of childhood blindness worldwide and for decades the standard of care has involved peripheral retinal ablation. However, this type of treatment requires the use of specialized equipment by well-trained physicians, has been associated with poor structural and visual outcomes in some preterm infants, and despite its adequate application, some cases of ROP may continue to progress. Therefore, the need for simpler and more efficient strategies made anti-vascular endothelial growth factor (anti-VEGF) medications an appealing option for treatment. Recently, the use of anti-VEGF agents for ROP has increased worldwide; nevertheless, this practice remains off-label, and there is a lack of information regarding its safety profile and the possibility of unfavorable long-term outcomes causes the utmost concern. This review updates the recent evidence regarding the systemic and ocular safety of anti-VEGF treatment for ROP.
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Affiliation(s)
- Ana Bety Enríquez
- Department of Ophthalmology, New England Eye Center, Tufts University School of Medicine, Boston, MA
| | | | - Caroline R Baumal
- Department of Ophthalmology, New England Eye Center, Tufts University School of Medicine, Boston, MA
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Sun M, Wadehra M, Casero D, Lin MC, Aguirre B, Parikh S, Matynia A, Gordon L, Chu A. Epithelial Membrane Protein 2 (EMP2) Promotes VEGF-Induced Pathological Neovascularization in Murine Oxygen-Induced Retinopathy. Invest Ophthalmol Vis Sci 2020; 61:3. [PMID: 32031575 PMCID: PMC7325623 DOI: 10.1167/iovs.61.2.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/07/2019] [Indexed: 02/07/2023] Open
Abstract
Purpose Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. ROP occurs as a consequence of postnatal hyperoxia exposure in premature infants, resulting in vasoproliferation in the retina. The tetraspan protein epithelial membrane protein-2 (EMP2) is highly expressed in the retinal pigment epithelium (RPE) in adults, and it controls vascular endothelial growth factor (VEGF) production in the ARPE-19 cell line. We, therefore, hypothesized that Emp2 knockout (Emp2 KO) protects against neovascularization in murine oxygen-induced retinopathy (OIR). Methods Eyes were obtained from wildtype (WT) and Emp2 KO mouse pups at P7, P12, P17, and P21 after normoxia or hyperoxia (P7-P12) exposure. Following hyperoxia exposure, RNA sequencing was performed using the retina/choroid layers obtained from WT and Emp2 KO at P17. Retinal sections from P7, P12, P17, and P21 were evaluated for Emp2, hypoxia-inducible factor 1α (Hif1α), and VEGF expression. Whole mount images were generated to assess vaso-obliteration at P12 and neovascularization at P17. Results Emp2 KO OIR mice demonstrated a decrease in pathologic neovascularization at P17 compared with WT OIR mice through evaluation of retinal vascular whole mount images. This protection was accompanied by a decrease in Hif1α at P12 and VEGFA expression at P17 in Emp2 KO animals compared with the WT animals in OIR conditions. Collectively, our results suggest that EMP2 enhances the effects of neovascularization through modulation of angiogenic signaling. Conclusions The protection of Emp2 KO mice against pathologic neovascularization through attenuation of HIF and VEGF upregulation in OIR suggests that hypoxia-induced upregulation of EMP2 expression in the neuroretina modulates HIF-mediated neuroretinal VEGF expression.
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Affiliation(s)
- Michel Sun
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
| | - Madhuri Wadehra
- Department of Pathology Lab Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
- Jonsson Comprehensive Cancer, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
| | - David Casero
- Department of Pathology Lab Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
| | - Meng-Chin Lin
- Division of Neonatology and Developmental Biology, Department of Pediatrics, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
| | - Brian Aguirre
- Department of Pathology Lab Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
| | - Sachin Parikh
- Laboratory of Ocular and Molecular Biology and Genetics, Jules Stein Institute, University of California-Los Angeles, Los Angeles, California, United States
| | - Anna Matynia
- Laboratory of Ocular and Molecular Biology and Genetics, Jules Stein Institute, University of California-Los Angeles, Los Angeles, California, United States
| | - Lynn Gordon
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
| | - Alison Chu
- Division of Neonatology and Developmental Biology, Department of Pediatrics, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
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VanderVeen DK, Cataltepe SU. Anti-vascular endothelial growth factor intravitreal therapy for retinopathy of prematurity. Semin Perinatol 2019; 43:375-380. [PMID: 31174872 DOI: 10.1053/j.semperi.2019.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Retinopathy of prematurity treatment modalities have expanded over the years, from cryotherapy to laser therapy and now, anti-vascular endothelial factor (VEGF) therapy by intravitreal injection. Use of anti-VEGF treatment varies regionally and depends on multiple factors including severity and progression of ROP, availability of alternative treatments, experience of the local ophthalmologists, medical status of the infant, and expectations for long-term follow-up. While the advantages and disadvantages of anti-VEGF intravitreal treatment on the eye are relatively well-described, few studies provide information about potential long-term systemic effects of this treatment, which is known to transiently reduce systemic VEGF concentrations.
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Affiliation(s)
- Deborah K VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School; Boston, MA, USA.
| | - Sule U Cataltepe
- Department of Pediatric Neonatology, Brigham and Women's Hospital, Harvard Medical School; Boston, MA, USA
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12
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Raghuram K, Isaac M, Yang J, AlAli A, Mireskandari K, Ly LG, Kelly E, Banihani R, Shah PS, Tehrani N. Neurodevelopmental outcomes in infants treated with intravitreal bevacizumab versus laser. J Perinatol 2019; 39:1300-1308. [PMID: 31341226 DOI: 10.1038/s41372-019-0420-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/16/2019] [Accepted: 04/27/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare neurodevelopmental and visual outcomes in preterm infants treated with intravitreal bevacizumab (IVB) to laser ablation at 18-24 months corrected age. STUDY DESIGN A retrospective study was performed. The primary outcome was neurodevelopmental impairment (NDI). Secondary neurodevelopmental outcomes were significant NDI (sNDI), cerebral palsy, hearing loss, and composite scores of the Bayley Scales of Infant Development, Third edition. Visual outcomes included structural and refractive outcomes. Adjusted odds ratios (AOR) were calculated controlling for GA, sex, and ROP severity and confounding baseline characteristics using a cutoff of p < 0.20. RESULTS Thirty-four (60 eyes) infants receiving IVB and 30 (51 eyes) laser were included. No significant differences were identified in NDI (AOR 1.77, 95% CI 0.46, 6.73) or sNDI (AOR 2.31, 95% CI 0.75, 7.14). There were no other differences in outcomes. CONCLUSIONS Larger randomized trials are required to establish long-term efficacy and safety of IVB in preterm neonates.
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Affiliation(s)
- Kamini Raghuram
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Maram Isaac
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Junmin Yang
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Alaa AlAli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Kamiar Mireskandari
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Linh G Ly
- Division of Neonatology Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Edmond Kelly
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Rudaina Banihani
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nasrin Tehrani
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada. .,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
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13
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Xu W, Wu Y, Hu Z, Sun L, Dou G, Zhang Z, Wang H, Guo C, Wang Y. Exosomes from Microglia Attenuate Photoreceptor Injury and Neovascularization in an Animal Model of Retinopathy of Prematurity. MOLECULAR THERAPY. NUCLEIC ACIDS 2019; 16:778-790. [PMID: 31163320 PMCID: PMC6545376 DOI: 10.1016/j.omtn.2019.04.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022]
Abstract
The role of microglia in the pathophysiology of ischemic retinal diseases has been studied extensively. Exosomes from microglial cells exert protective effects during several nervous system diseases, but their roles in hypoxia-induced retinopathy remain unclear. In our study, exosomes derived from microglial cells were injected into the vitreous body of mice with oxygen-induced retinopathy (OIR). Results showed that exosome-treated OIR mice exhibited smaller avascular areas and fewer neovascular tufts in addition to decreased vascular endothelial growth factor (VEGF) and transforming growth factor β (TGF-β) expression. Moreover, photoreceptor apoptosis was suppressed by exosome injection. Mechanistically, exosomes from microglial cells were incorporated into photoreceptors in vitro and inhibited the inositol-requiring enzyme 1α (IRE1α)-X-box binding protein 1 (XBP1) cascade, which contributes to hypoxia-induced photoreceptor apoptosis. Furthermore, the exosomes also downregulated the mRNA and protein levels of VEGF and TGF-β in hypoxia-exposed photoreceptors. A microRNA assay showed that microRNA-24-3p (miR-24-3p) levels were extremely high in exosomes from microglial cells, suggesting that this could be the key molecule that inhibits the hypoxia-induced expression of IRE1α in photoreceptors. These findings delineate a novel exosome-mediated mechanism of microglial cell-photoreceptor crosstalk that facilitates normal angiogenesis and visual function in OIR mice; thus, our results also suggest a potential therapeutic approach for retinopathy of prematurity.
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Affiliation(s)
- Wenqin Xu
- Department of Ophthalmology, Eye Institute of China PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ying Wu
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhicha Hu
- Department of Ophthalmology, Eye Institute of China PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Lijuan Sun
- Department of Ophthalmology, Eye Institute of China PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guorui Dou
- Department of Ophthalmology, Eye Institute of China PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zifeng Zhang
- Department of Ophthalmology, Eye Institute of China PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Haiyang Wang
- Department of Ophthalmology, Eye Institute of China PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Changmei Guo
- Department of Ophthalmology, Eye Institute of China PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yusheng Wang
- Department of Ophthalmology, Eye Institute of China PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
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