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Ortiz-Seller A, Martorell P, Barranco H, Pascual-Camps I, Morcillo E, Ortiz JL. Comparison of different agents and doses of anti-vascular endothelial growth factors (aflibercept, bevacizumab, conbercept, ranibizumab) versus laser for retinopathy of prematurity: A network meta-analysis. Surv Ophthalmol 2024; 69:585-605. [PMID: 38432359 DOI: 10.1016/j.survophthal.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/10/2024] [Accepted: 02/27/2024] [Indexed: 03/05/2024]
Abstract
Laser photocoagulation (LPC) and/or intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections constitute the current standard treatment for retinopathy of prematurity (ROP). This network meta-analysis focus on whether a ranking of interventions may be established for different dose levels of intravitreal injection of anti-VEGF agents (aflibercept, bevacizumab, conbercept, ranibizumab) as primary treatments for ROP versus laser in terms of retreatment rate as primary outcome, and time to retreatment and refractive error as secondary endpoints, since best anti-VEGF dosage remains under debate. Sixty-eight studies (15 randomized control trials and 53 nonrandomized studies) of 12,356 eyes of 6445 infants were retrieved from databases (2005 Jan. - 2023 June). Studies were evaluated for model fit, risk of bias and confidence of evidence in Network Meta-Analysis (CINeMA). Bayesian NMA showed that anti-VEGF drugs were not inferior to laser in terms of retreatment rate. For intravitreal bevacizumab (IVB), doses half of the conventional infant dose showed a low risk of retreatment rate (risk ratio (RR) of 1.43; 95% credible interval (CrI): 0.508, 4.03). On probability ranking as surface under the cumulative ranking curve (SUCRA) plot, half dose of bevacizumab had a better position than conventional and augmented (1.2-2 times the regular dose) doses. A similar probability trend was observed for half vs. conventional doses of aflibercept and ranibizumab. Conventional infant dose of conbercept showed the lowest risk for retreatment (RR 0.846; 95% CrI: 0.245, 2.91). For secondary endpoints, lower doses of anti-VEGF agents were associated with shorter times to retreatment. The largest changes were noted for the augmented doses of bevacizumab and ranibizumab (0.3 mg) with means of 14.1 weeks (95% CrI: 6.65, 21.6) and 12.8 weeks (95% CrI: 3.19, 20.9), respectively. Finally, NMA demonstrated better refractive profile for anti-VEGF than laser therapy, especially for the conventional infant doses of bevacizumab and ranibizumab which exhibited a significantly better refractive profile than LPC, with mean differences of 1.67 (spherical equivalent - diopters) (95% CrI: 0.705, 2.67) and 2.19 (95% CrI: 0.782, 3.59), respectively. In the SUCRA plots, LPC had a markedly different position with a higher probability for myopia. Further clinical trials comparing different intravitreal doses of anti-VEGF agents are needed, but our findings suggest that low doses of these drugs retain efficacy and may reduce ocular and systemic undesired events.
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Affiliation(s)
- Amparo Ortiz-Seller
- Unit of Paediatric Ophthalmology and Strabismus, Oftalvist Clinic, Valencia, Spain
| | - Pablo Martorell
- Department of Chemical and Nuclear Engineering, Universitat Politècnica de València, Spain
| | - Honorio Barranco
- Unit of Paediatric Ophthalmology and Strabismus, La Fe University and Polytechnic Hospital of Valencia, Spain
| | - Isabel Pascual-Camps
- Unit of Paediatric Ophthalmology and Strabismus, La Fe University and Polytechnic Hospital of Valencia, Spain
| | - Esteban Morcillo
- Health Research Institute (INCLIVA) of the Clinic University Hospital of Valencia and Department of Pharmacology, Faculty of Medicine, Universitat de València, Spain
| | - José L Ortiz
- Department of Pharmacology, Faculty of Medicine, Universitat de València, Spain.
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Pfeil JM, Barth T, Lagrèze WA, Lorenz B, Hufendiek K, Liegl R, Breuss H, Bemme S, Aisenbrey S, Glitz B, Süsskind D, Gabel-Pfisterer A, Skevas C, Krohne TU, Kakkassery V, Bründer MC, Engelmann K, Guthoff R, Walter P, Choritz L, Stahl A. Treated Cases of Retinopathy of Prematurity in Germany: 10-Year Data from the Retina.net Retinopathy of Prematurity Registry. Ophthalmol Retina 2024; 8:579-589. [PMID: 38104929 DOI: 10.1016/j.oret.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To analyze changes in demographic parameters and retreatment patterns over a 10-year period in a clinical routine setting of infants with retinopathy of prematurity (ROP) requiring treatment documented in the German Retina.net ROP registry. DESIGN Multicenter, noninterventional, observational registry study recruiting patients treated for ROP. SUBJECTS A total of 692 eyes of 353 infants treated for ROP were documented in the Retina.net ROP registry over a 10-year period between 2011 and 2020. These cases cover about 15% of all infants treated for ROP in Germany. METHODS The Retina.net ROP registry was established in 2012 to jointly collect information on infants treated for ROP. The database collects information on demographic parameters (gestational age [GA], birth weight, neonatal comorbidities) as well as treatment parameters (type of treatment, weight and age at treatment, and stage of ROP). A total of 19 centers contributed to the analysis. This is the 10-year analysis of data from 2011 to 2020, in which we focus on changes over time regarding the respective parameters. MAIN OUTCOME MEASURES Changes over time in demographic parameters and treatment patterns for ROP in Germany. RESULTS The overall incidence of treatment requiring ROP was 3.5% of all infants screened for ROP at participating centers. Gestational age, weight at birth, and weight at treatment remained stable over the 10-year period, whereas postmenstrual and postnatal age at treatment increased moderately but statistically significantly over the years. The most prevalent ROP severity stage at treatment was stage 3+ in zone II (76.6% of all treated eyes). Treatment patterns changed considerably from predominantly laser treatments in 2011 (75% of all treated eyes) to predominantly ranibizumab treatments in 2020 (60.9% of all treated eyes). The overall retreatment rate was 15.6%. Retreatment rates differed between initial treatment modalities (14.1% after laser coagulation, 12% after bevacizumab and 24.5% after ranibizumab). Treatment-associated systemic or ophthalmic complications were rare. CONCLUSIONS This data analysis represents one of the largest documented cohorts of infants treated for ROP. The data on demographic parameters and treatment patterns provide useful information for further improvement of ROP management. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Johanna M Pfeil
- Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany
| | - Teresa Barth
- Department of Ophthalmology, University of Regensburg, Regensburg, Germany
| | - Wolf A Lagrèze
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Birgit Lorenz
- Department of Ophthalmology, Justus-Liebig University Giessen, Giessen, Germany
| | | | - Raffael Liegl
- Department of Ophthalmology, University Medicine Bonn, Bonn, Germany
| | - Helge Breuss
- Department of Ophthalmology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Sebastian Bemme
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
| | - Sabine Aisenbrey
- Department of Ophthalmology, Vivantes Klinikum Neukoelln, Berlin, Germany
| | - Barbara Glitz
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | - Daniela Süsskind
- University Eye Hospital, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | | | - Christos Skevas
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim U Krohne
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Vinodh Kakkassery
- Department of Ophthalmology, University of Luebeck, Luebeck, Germany
| | | | - Katrin Engelmann
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Rainer Guthoff
- Department of Ophthalmology, Faculty of Medicine, University of Duesseldorf, Duesseldorf, Germany
| | - Peter Walter
- Department of Ophthalmology, University Hospital RWTH Aachen, Germany
| | - Lars Choritz
- Department of Ophthalmology, Otto von Guericke University, Magdeburg, Germany
| | - Andreas Stahl
- Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany.
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Chopra J, Haider KM, Boente CS. Comparing reactivation and retreatment for three doses of bevacizumab in type 1 retinopathy of prematurity. J AAPOS 2024; 28:103866. [PMID: 38458598 PMCID: PMC10999324 DOI: 10.1016/j.jaapos.2024.103866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/24/2023] [Accepted: 01/08/2024] [Indexed: 03/10/2024]
Abstract
PURPOSE To determine timing and rates of reactivation and retreatment of type 1 retinopathy of prematurity (ROP) after treatment with either 0.125 mg, 0.250 mg, or 0.500 mg of intravitreal bevacizumab (IVB). METHODS Retrospective data, including demographic information, past medical history, and ROP characteristics were analyzed for babies with type 1 ROP treated with IVB at Riley Hospital for Children for the perioed 2014-2021. RESULTS A total of 84 patients met inclusion criteria: 29 patients received 0.125 mg of IVB; 39, 0.250 mg; and 16, 0.500 mg. Of the 84, 67 (80%) had additional laser treatment because of late reactivation (n = 52) or persistent avascular retina (PAR) (n = 15). Subsequent laser treatment was more common with lower doses: 0.125 mg (n = 27 [93%]); 0.250 mg (n = 31 [80%]); 0.500 mg (n = 9 [57%]) (P = 0.012). There was no difference between groups with regard to reason for subsequent laser treatment (reactivation vs PAR). The 0.125 mg group required retreatment because of reactivation 3.8 weeks sooner than the other dosing groups (P = 0.047). CONCLUSIONS The outcomes comparing three doses of IVB for severe ROP showed a difference in the timing of secondary treatment, with the lower dosing group requiring laser for reactivation earlier.
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Affiliation(s)
- Jay Chopra
- Indiana University School of Medicine, Indianapolis
| | - Kathryn M Haider
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - Charline S Boente
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis.
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Modrzejewska M, Nazwalska M. The Long-Term Observation of the Beneficial Effects of Treatment: 0.12 mg Anti-VEGF Monotherapy or Anti-VEGF Combined Therapy and Diode-Laser in Various Stages of Retinopathy of Prematurity-Series of Cases. J Clin Med 2023; 12:5644. [PMID: 37685711 PMCID: PMC10488330 DOI: 10.3390/jcm12175644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/20/2023] [Accepted: 07/11/2023] [Indexed: 09/10/2023] Open
Abstract
Background 2-year observations of ranibizumab monotherapy and combined therapy with diode laser for severe ROP in extremely prematures. Materials and methods: In a group of 18 prematures (n = 36 eyes; 5 study groups); 25.8 ± 1.5 Hbd, birth weight 796.5 ± 166.1 g. Apgar 4.62 ± 1.88) with A-ROP (n = 22; 61%) and 3 ROP (plus) (n = 14; 39%), ranibizumab monotherapy (n = 4 eyes) in dose 0.12 mg/0.12 mL or with diode laser (n = 32 eyes) were applied. The first intervention was carried out in PMA of 33 (gr. 4 and 5) and 34 in (gr. 1, 2, 3), mean follow-up time 21.44 ± 8.7 months. One-way analysis of variance (ANOVA) with Welch's correction, non-parametric Kruskal-Wallis test, Chi square test of independence were used. A retrospective observational study based on a case series. Results Retinal attachment was achieved in 92.3% of the studied eyes. Bilateral retinal detachment was noted in 1 infant (2 eyes). Myopization (-0.75 to -7.5 D) was observed in 5 infants (45%); mild hyperopia (+0.5 to +4.5 D) was observed in the rest infants (55%). Conclusions Individualization strategies in severe ROP with lower dose 0.12 mg Ranibizumab or combined laser-therapy resulted in effective outcomes. Myopia has not been reported in patients where Ranibizumab was the first drug administered in the ROP treatment strategy.
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Affiliation(s)
- Monika Modrzejewska
- Second Department of Ophthalmology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Martyna Nazwalska
- Department of Ophthalmology, Independent Public Health Care Center of the Ministry of the Interior and Administration (SP ZOZ MSWiA), ul. Jagiellońska 44, 70-382 Szczecin, Poland;
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Lam M, Suh D. Screening, Diagnosis, and Treatment of Pediatric Ocular Diseases. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121939. [PMID: 36553382 PMCID: PMC9777216 DOI: 10.3390/children9121939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Vision is an important aspect of a child's quality of life and intellectual, social, and emotional development. Disruptions to vision during infancy and early childhood can cause lifelong vision impairment or blindness. However, early identification and treatment of eye disease can prevent loss of sight and its consequent long-term effects. Therefore, screening guidelines exist to guide physicians in detecting the most common threats to sight in the different stages of infancy and childhood. This review describes common causes of pediatric vision impairment, the recommended screening guidelines for diagnosing them, and current treatment modalities.
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Affiliation(s)
- Matthew Lam
- Creighton University School of Medicine Phoenix Regional Campus, Phoenix, AZ 85012, USA
| | - Donny Suh
- Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA
- Correspondence:
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Chang E, Josan AS, Purohit R, Patel CK, Xue K. A Network Meta-Analysis of Retreatment Rates following Bevacizumab, Ranibizumab, Aflibercept, and Laser for Retinopathy of Prematurity. Ophthalmology 2022; 129:1389-1401. [PMID: 35842190 DOI: 10.1016/j.ophtha.2022.06.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 01/06/2023] Open
Abstract
TOPIC To compare bevacizumab, ranibizumab, aflibercept, and laser treatment as primary therapies for retinopathy of prematurity (ROP) in terms of retreatment rate. CLINICAL RELEVANCE Anti-VEGF agents are increasingly used as primary treatment for ROP and may provide superior outcomes compared with laser in posterior disease. Head-to-head comparisons between different anti-VEGFs are lacking. METHODS We searched CENTRAL, Embase, MEDLINE, and CINAHL databases for randomized controlled trials and nonrandomized comparative studies that had been reported as of March 2022. We included studies that used bevacizumab, ranibizumab, aflibercept or laser for ROP with comparable cohorts and treatment criteria. Studies were evaluated by the Grading of Recommendations, Assessment, Development and Evaluation framework, and those with biased case selection, nonrandomized case-control, or lack of control group were excluded. Frequentist meta-analyses of proportions determined the absolute primary retreatment rate of each modality and Bayesian network meta-analyses compared pairs of treatments in type 1 and Zone I ROP. RESULTS In all, 30 studies (4686 eyes) were included in the network meta-analyses. For type 1 ROP, single-treatment success rates (i.e., likelihood of needing no further treatment) were 89.3% (95% confidence interval [CI]: 83.8%-93.8%; n = 1552) for laser, 87.0% (95% CI: 78.6%-93.8%; n = 2081) for bevacizumab, 80.7% (95% CI: 62.0%-94.4%; n = 326) for aflibercept, and 74.0% (95% CI: 62.7%-84.1%; n = 727) for ranibizumab. Bayesian network meta-analysis indicates that laser treatment is associated with a significant 62% (95% credible interval [CrI]: 16%-83%) reduction in retreatment risk compared with ranibizumab, while no significant difference was found among other pairwise comparisons. The mean ± standard error of the mean times to secondary treatment following primary aflibercept (12.96 ± 0.47 weeks) and bevacizumab (11.36 ± 0.54 weeks) therapy were significantly longer than that for primary ranibizumab (9.29 ± 0.43weeks) therapy (P = 7 × 10-7 and P = 9 × 10-3, respectively). For Zone I ROP, single-treatment success rates were 91.2% (95% CI: 83.6-96.9; n = 231) for bevacizumab, 78.3% (95% CI: 61.4-91.9; n = 100) for ranibizumab, and 65.9% (95% CI: 41.4-87.2; n = 158) for laser treatment. In this case, Bayesian network meta-analysis suggests that primary bevacizumab is associated with a significant 67% (95% CrI:10%-90%) reduction in retreatment risk compared with laser treatment. CONCLUSIONS Laser was associated with a lower rate of retreatment than ranibizumab in type 1 ROP (Zones I and II combined), while bevacizumab was associated with a lower rate of retreatment than laser in Zone I ROP. Aflibercept and bevacizumab demonstrate longer duration of action than ranibizumab for ROP.
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Affiliation(s)
- Emer Chang
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Amandeep S Josan
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Ravi Purohit
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Chetan K Patel
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Ophthalmology Department, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | - Kanmin Xue
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
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[Risk factors for recurrence after intravitreal anti-vascular endothelial growth factor injection for retinopathy of prematurity]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:1207-1212. [PMID: 36398545 PMCID: PMC9678068 DOI: 10.7499/j.issn.1008-8830.2205011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To investigate the efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection in the treatment of retinopathy of prematurity (ROP) and the risk factors for recurrence. METHODS A retrospective analysis was performed on the medical data of 159 infants with ROP who were born in the First Affiliated Hospital of Zhengzhou University and underwent anti-VEGF treatment from January 2016 to December 2021. According to the presence or absence of recurrence within the follow-up period after initial anti-VEGF treatment, they were divided into a recurrence group with 24 infants and a non-recurrence group with 135 infants. The medical data were compared between the two groups, and a multivariate logistic regression analysis was used to investigate the risk factors for the recurrence of ROP after anti-VEGF treatment. RESULTS After one-time anti-VEGF treatment, all 159 infants showed regression of plus disease. Recurrence was observed in 24 infants (15.1%) after anti-VEGF treatment, with a mean interval of (8.4±2.6) weeks from treatment to recurrence. The multivariate logistic regression analysis showed that preoperative fundus hemorrhage and prolonged total oxygen supply time were risk factors for the recurrence of ROP (P<0.05), while gestational hypertension was a protective factor (P<0.05). CONCLUSIONS Intravitreal anti-VEGF injection is effective for ROP. Preoperative fundus hemorrhage and long duration of oxygen therapy may increase the risk of ROP recurrence, and further studies are needed to investigate the influence of gestational hypertension on the recurrence of ROP.
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Bassiouny RM, Gaafar WM, El Nokrashy A, Abdelhameed AG, Attallah EA, Elgharieb AG, Bassiouny MR. Clinical outcome following reinjection of Ranibizumab for reactivation of retinopathy of prematurity. Eye (Lond) 2022; 36:2137-2143. [PMID: 34711941 PMCID: PMC9581953 DOI: 10.1038/s41433-021-01814-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/17/2021] [Accepted: 10/05/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To assess reactivation after initial intravitreal injection of ranibizumab (IVR) for type 1 retinopathy of prematurity (ROP) or worse and the outcome following reinjection of ranibizumab for this reactivation. METHODS This retrospective study was performed on infants screened for ROP between March 2013 and February 2020 in Mansoura University Children Hospital, Mansoura, Egypt. Infants treated with ranibizumab 0.25 mg/0.025 mL were identified for review of their clinical outcomes. Data of infants with reactivation and IVR re-injection were analysed. RESULTS A total of 2318 infants were screened for ROP, 115 (5%) infants (216 eyes) with a mean gestational age of 30 ± 2.5 weeks and mean birth weight of 1290 ± 355.2 g received IVR at mean postmenstrual age (PMA) of 38 ± 3.1 weeks. All treated eyes demonstrated initial regression of ROP. However, ROP reactivation occurred in 5 (2.3%) eyes of 3 patients, at an average of 9.6 ± 2.9 weeks after treatment. None of these eyes had retinal detachment. A second dose IVR was administered and all five eyes showed regression with complete retinal vascularisation, at a mean PMA of 60 ± 5.1 weeks. CONCLUSIONS IVR is beneficial as an initial and subsequent treatment for type 1 ROP or APROP. A long-term follow-up until complete retinal vascularisation is recommended to avoid disease reactivation.
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Affiliation(s)
- Rania M Bassiouny
- Lecturer of Ophthalmology, Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Walid M Gaafar
- Associate Professor of Ophthalmology, Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Amgad El Nokrashy
- Lecturer of Ophthalmology, Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ameera G Abdelhameed
- Associate Professor of Ophthalmology, Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Eman A Attallah
- Assistant Lecturer of Ophthalmology, Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed G Elgharieb
- Assistant Lecturer of Ophthalmology, Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed R Bassiouny
- Professor of Pediatrics, Department of Pediatrics, Mansoura University Children Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Chen Y, Wang S, Chen S, Chen X, Han L, Zhong Q, Zhang K. Appropriate dose of intravitreal ranibizumab for ROP: a retrospective study. BMC Ophthalmol 2022; 22:271. [PMID: 35729540 PMCID: PMC9210651 DOI: 10.1186/s12886-022-02489-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To compare the recurrence rate of retinopathy of prematurity (ROP) after treatment with 0.3 mg vs. 0.25 mg ranibizumab. Subjects All patients with ROP who underwent intravitreal injection of ranibizumab in Hainan General Hospital between January 2014 and May 2020 were included in this retrospective study. Methods Eighty-two cases (146 eyes) who received intravitreal injection of 0.25 mg ranibizumab were included in the conventional-dose group, and 59 cases (108 eyes) who received intravitreal injection of 0.3 mg ranibizumab were included in the high-dose group. The two groups were further divided into the 25-28-week, 29-31-week, 32-34-week, and 35-36-week GA subgroups. The differences between the conventional-dose group and the high-dose group in gestational age (GA), birth weight (BW), age at initial injection (weeks), incidence of systemic diseases, the recurrence rate of ROP, and age at retinal vascularization completed (weeks) were analyzed. Results GA, BW, age at initial injection, and the incidence of systemic diseases were not significantly different between the conventional-dose group and the high-dose group (p > 0.05). The recurrence rates of ROP were significantly lower in the 25-28-week, 29-31-week, and 32-34-week subgroups of the high-dose group than in the same subgroups of the conventional-dose group (p < 0.05). Within the conventional-dose group, the recurrence rate of ROP was significantly lower in the 32-34-week and 35-36-week subgroups than in the 25-28-week and 29-31-week subgroups (p < 0.05). Within the high-dose group, the recurrence rate of ROP was not significantly different between the four subgroups (p > 0.05). Retinal vascularization was completed at a later age in the 32-34-week subgroup of the high-dose group than in the 32-34-week subgroup of the conventional-dose group (p < 0.05) but was not significantly different between the two groups at any other GA range (p > 0.05). No severe ocular or systemic complications occurred in any patient. Conclusion Treatment with 0.3 mg ranibizumab can reduce the recurrence rate of ROP without prolonging retinal vascularization or causing serious systemic complications. Therefore, this dose may be an appropriate therapeutic dose for ROP.
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Affiliation(s)
- Yingying Chen
- Hainan General Hospital , Hainan Affiliated Hospital Of Hainan Medical University, Xiuhua road, Hainan General Hospital, Hainan, China
| | - Shaoli Wang
- Hainan General Hospital , Hainan Affiliated Hospital Of Hainan Medical University, Xiuhua road, Hainan General Hospital, Hainan, China
| | - Siying Chen
- Hainan General Hospital , Hainan Affiliated Hospital Of Hainan Medical University, Xiuhua road, Hainan General Hospital, Hainan, China
| | - Xingyue Chen
- Hainan General Hospital , Hainan Affiliated Hospital Of Hainan Medical University, Xiuhua road, Hainan General Hospital, Hainan, China
| | - Lizhen Han
- Hainan General Hospital , Hainan Affiliated Hospital Of Hainan Medical University, Xiuhua road, Hainan General Hospital, Hainan, China
| | - Qionglei Zhong
- Hainan General Hospital , Hainan Affiliated Hospital Of Hainan Medical University, Xiuhua road, Hainan General Hospital, Hainan, China.
| | - Kaiyan Zhang
- Hainan General Hospital , Hainan Affiliated Hospital Of Hainan Medical University, Xiuhua road, Hainan General Hospital, Hainan, China.
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Stahl A, Bründer M, Lagrèze WA, Molnár FE, Barth T, Eter N, Guthoff R, Krohne TU, Pfeil JM, Bühler A, Daniel M, Felzmann S, Gross N, Horn S, Müller C, Reichl S, Reiff C, Richter O, Stech M, Hentschel R, Stavropoulou D, Tautz J, Bartsch K, Braunstein J, Brinken R, Brinkmann CK, Czauderna J, Dralle W, Gliem M, Goebel A, Heymer P, Hofmann M, Holz FG, Kupitz D, Müller P, Petrak M, Schmitz EJ, Schmitz‐Valckenberg S, Schröder M, Steinberg J, Supé J, Kant E, Kunze D, Müller A, Adorf A, Alex A, Alten F, Clemens CR, Falkenau S, Friedhoff C, Loos DS, Mihailovic N, Termühlen J, Uhlig C, Hörnig‐Franz I, Rieger‐Fackeldey E, Tekaat M, Werner C, Altmann M, Blecha C, Brandl S, Helbig H, Hufendiek K, Jägle H, Konrad J, Kopetzky E, Lehmann F, Oberacher‐Velten I, Keller‐Wackerbauer A, Kittel J, Segerer H, Ackermann P, Benga J, Guthoff T, Kleinert E, Mayatepek E, Schrader S, Völker M, Höhn T, Lohmeier K, Sabir H, Mayatepek E, Brevis F, Mönig T, Schwarz S, Ehmer A, Meltendorf S, Schuart C, Avenarius S, Böttger R, Apel C, Bergmann A, Herrmann K, Ockert‐Schön F, Wegener S, Ehrt O, Nentwich M, Pressler A, Rudolph G, Genzel‐Boroviczeny O, Schmidt S, Münch H, Thilmany C, Aisenbrey S, Bruckmann A, Dimopoulos S, Hagemann U, Inhoffen W, Partsch M, Schrader M, Süsskind D, Völker M, Bialkowski A, Müller‐Hansen I, Gerberth A, Hasselbach HC, Lindemann S, Purtskhvanidze K, Raffel Y, Roider J, Gerding H, Jandeck C, Smith L. Ranibizumab in retinopathy of prematurity - one-year follow-up of ophthalmic outcomes and two-year follow-up of neurodevelopmental outcomes from the CARE-ROP study. Acta Ophthalmol 2022; 100:e91-e99. [PMID: 33742551 PMCID: PMC9460412 DOI: 10.1111/aos.14852] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/27/2021] [Indexed: 12/01/2022]
Abstract
Purpose: The primary endpoint results from the comparing alternative ranibizumab dosages for safety and effcacy in retinopathy of prematurity (CARE-ROP) core study identified ranibizumab as an effective treatment to control acute retinopathy of prematurity (ROP). This study reports the 1- and 2-year follow-up data focusing on long-term functional outcomes and safety. Methods: The CARE-ROP trial compared 0.12 mg versus 0.20 mg ranibizumab in 20 infants with ROP in a multicentric, prospective, randomized, double-blind, controlled study design. Sixteen patients entered the follow-up period. An ophthalmologic assessment at one year postbaseline was acquired from all 16 patients and a neurodevelopmental assessment at two years postbaseline was acquired from 15 patients. Results: Fifteen of 16 infants were able to fixate and follow moving objects at one year postbaseline treatment. One child progressed to stage 5 ROP bilaterally between the end of the core study and the 1-year follow-up (first seen at PMA 75 weeks). Mean spherical equivalents were −1.9 diopters (D) and −0.75 D in the 0.12 mg and the 0.20 mg treatment arms. Strabismus was present in seven and nystagmus in five out of 16 infants. Mental development scores were within normal limits in six out of ten patients with available data. No statistically significant difference was observed between the two treatment arms. Conclusion: Neurodevelopmental and functional ocular outcomes 1 and 2 years after treatment with ranibizumab are reassuring regarding long-term safety. Late reactivation of ROP, however, represents a challenge during the follow-up phase and it is of utmost importance that regular follow-ups are maintained.
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Affiliation(s)
- Andreas Stahl
- Department of Ophthalmology University Medicine Greifswald Greifswald Germany
| | | | - Wolf A. Lagrèze
- Eye Center Medical Center Faculty of Medicine University of Freiburg Freiburg Germany
| | - Fanni E. Molnár
- Eye Center Medical Center Faculty of Medicine University of Freiburg Freiburg Germany
| | - Teresa Barth
- Department of Ophthalmology University of Regensburg Regensburg Germany
| | - Nicole Eter
- Department of Ophthalmology University of Muenster Medical Center Muenster Germany
| | - Rainer Guthoff
- Department of Ophthalmology Faculty of Medicine University of Dusseldorf Dusseldorf Germany
| | - Tim U. Krohne
- Department of Ophthalmology Faculty of Medicine University Hospital Cologne University of Cologne Cologne Germany
| | - Johanna M. Pfeil
- Department of Ophthalmology University Medicine Greifswald Greifswald Germany
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Fadakar K, Mehrabi Bahar M, Riazi-Esfahani H, Azarkish A, Farahani AD, Heidari M, Bazvand F. Intravitreal bevacizumab to treat retinopathy of prematurity in 865 eyes: a study to determine predictors of primary treatment failure and recurrence. Int Ophthalmol 2022; 42:2017-2028. [DOI: 10.1007/s10792-021-02198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
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Iwahashi C, Utamura S, Kuniyoshi K, Sugioka K, Konishi Y, Wada N, Kusaka S. FACTORS ASSOCIATED WITH REACTIVATION AFTER INTRAVITREAL BEVACIZUMAB OR RANIBIZUMAB THERAPY IN INFANTS WITH RETINOPATHY OF PREMATURITY. Retina 2021; 41:2261-2268. [PMID: 33958533 DOI: 10.1097/iae.0000000000003196] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the efficacy and risk factors of intravitreal antivascular endothelial growth factor injection (anti-VEGF therapy) for retinopathy of prematurity (ROP). METHODS We retrospectively reviewed 80 consecutive eyes of 43 patients with Type 1 ROP or worse who received anti-VEGF therapy during January 2012-February 2018. Patients were divided into those who were injected with 0.25 mg of bevacizumab (IVB group, 37 eyes) and 0.25 mg of ranibizumab (IVR group, 43 eyes). Serum VEGF concentrations of 18 patients were measured before and after IVR. RESULTS Antivascular endothelial growth factor injection therapy reduced ROP activity in all eyes; however, 14 eyes (17.5%) exhibited reactivation. The reactivation rates of the IVB and IVR groups were 13.5% and 20.9%, respectively (P = 0.556). Multivariate logistic regression analysis showed that postmenstrual age ≤35 weeks at anti-VEGF therapy (P = 0.014) and aggressive posterior ROP (P = 0.044) was significantly associated with reactivation. Serum VEGF was significantly suppressed at Days 1 (P < 0.001) and 7 (P = 0.012) after IVR and returned to the preinjection level by Day 14 (P = 0.210). CONCLUSION Both IVR and IVB seemed effective in reducing ROP activity. Reactivation after anti-VEGF therapy may be associated with younger postmenstrual age at anti-VEGF therapy and aggressive posterior ROP.
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Affiliation(s)
| | | | | | | | - Yuhei Konishi
- Pediatrics, Kindai University Faculty of Medicine, Osaka, Japan
| | - Norihisa Wada
- Pediatrics, Kindai University Faculty of Medicine, Osaka, Japan
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Katargina LA, Chesnokova NB, Beznos OV, Osipova NA, Panova AY. [Pathogenetically oriented approach to prevention of retinopathy of prematurity (experimental study)]. Vestn Oftalmol 2021; 137:26-31. [PMID: 34156775 DOI: 10.17116/oftalma202113703126] [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
Intraperitoneal injections of exogenous melatonin during the development of the retinal vascular system in experimental rats has been shown in a number of experimental studies on the model of EROP to prevent the appearance of histological signs of the development of experimental retinopathy of prematurity (EROP), stabilize the blood-retinal barrier and have a pronounced antioxidant effect, but pathogenetic basis for these phenomena hasn't been studied. PURPOSE To study the influence mechanism of melatonin and its analogues on the development of EROP at the preclinical stage of the pathological process to substantiate new approaches to prevention of ROP. MATERIAL AND METHODS The study included 42 Wistar rat pups (84 eyes) divided into 6 groups: control group, experimental group (rat pups with EROP), experimental groups who underwent injections of melatonin and its analogues K-148, AL-3, K-096. The pups were euthanized on day 7 (4-5 pups from each group at each study period), binocular enucleation was performed, and the content of hypoxia-induced factor1α (HIF-1α) and VEGF-A was determined in retinal samples. RESULTS The intraperitoneal injections of melatonin and its analogs led to a significant decrease in the level of HIF-1α and VEGF-A in the retina of the rat pups of the experimental group until the beginning of pathological vasoproliferation. CONCLUSION Melatonin and its analogues are able to prevent the development of EROP by reducing the level of angiogenic factors in the retina of rat pups at the stage of existing avascular zones, which allows for them to be considered as a new promising approach to preventing the development of ROP.
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Affiliation(s)
- L A Katargina
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - N B Chesnokova
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - O V Beznos
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - N A Osipova
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - A Yu Panova
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
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Wu Z, Zhao J, Lam W, Yang M, Chen L, Huang X, Wei M, Yang H, Lv F, Zhang F, Zeng J, Zhang GM. Comparison of clinical outcomes of conbercept versus ranibizumab treatment for retinopathy of prematurity: a multicentral prospective randomised controlled trial. Br J Ophthalmol 2021; 106:975-979. [PMID: 33637618 PMCID: PMC9234416 DOI: 10.1136/bjophthalmol-2020-318026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/24/2021] [Accepted: 02/11/2021] [Indexed: 11/17/2022]
Abstract
Purpose To compare the recurrence rate and surgical complications of retinopathy of prematurity (ROP) between patients treated with intravitreal injection of conbercept (IVC) and intravitreal injection of ranibizumab (IVR) within 6 months. Methods A multicentral prospective, randomised controlled trial was applied from May 2017 to February 2019 for the infants diagnosed as aggressive posterior-ROP, zone I or posterior zone II treatment-requiring ROP by binocular indirect ophthalmoscope and RetCam3. These infants were assigned to randomly receive either intravitreal injection of 0.25 mg conbercept or 0.25 mg ranibizumab. The recurrence rate, fundus fluorescence angiography (FFA) and surgical complications were examined during the follow-up period of 6 months. Recurrent eyes were retreated by laser or another intravitreal injection within the 72 hours. Results A total of 30 infant patients (60 eyes) underwent IVC and 30 patients (60 eyes) underwent IVR. A total of 10 eyes (16.67%) in the IVC group and 14 eyes (23.34%) in the IVR group developed recurrence. There was no significant statistical difference in the recurrence rate between the two groups (χ2=0.83, p=0.36). The postmenstrual age (PMA) at first injection was (34.60±3.47) weeks in IVC and (35.14±1.76) in IVR group. In recurrent cases, the mean PMA at second treatment were (43.31±3.85) and (43.43±3.89) weeks in the IVC and IVR group, respectively. The period between two treatments was (8.71±6.62) for the IVC and (8.29±2.56) weeks for the IVR group. All these results showed no significant statistical difference between these two groups. The fluorescein leakage were observed in the eyes of recurrent infants by FFA. There were no other complications in the two groups except for complicated cataract in three eyes. Conclusion Both IVC and IVR are effective therapies for the treatment of ROP. Conbercept is a new option for treating ROP.
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Affiliation(s)
- Zhenquan Wu
- Ophthalmology, Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China, Shenzhen, Guangdong, China
| | - Jinfeng Zhao
- Ophthalmology, Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China, Shenzhen, Guangdong, China
| | - Waiching Lam
- Ophthalmology, The University of Hong Kong, Grantham Hospital, Hong Kong, China
| | - Mingmin Yang
- Ophthalmology, Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China, Shenzhen, Guangdong, China
| | - Lu Chen
- Ophthalmology, Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China, Shenzhen, Guangdong, China
| | - Xuelin Huang
- Ophthalmology, Guangdong Provincial Maternity and Children's Hospital, Guangzhou, Guangdong, China
| | - Meirong Wei
- Ophthalmology, Liuzhou Maternity and Children's Hospital, Liuzhou, China
| | - Hui Yang
- Ophthalmology, Xiamen Children's Hospital, Xiamen, China
| | - Fan Lv
- Ophthalmology, Quanzhou Children's Hospital, Quanzhou, China
| | - Fuyan Zhang
- Ophthalmology, Guizhou Medical University, Guiyang, Guizhou, China
| | - Jian Zeng
- Ophthalmology, Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China, Shenzhen, Guangdong, China
| | - Guo-Ming Zhang
- Ophthalmology, Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China, Shenzhen, Guangdong, China
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Relapse of pathological angiogenesis: functional role of the basement membrane and potential treatment strategies. Exp Mol Med 2021; 53:189-201. [PMID: 33589713 PMCID: PMC8080572 DOI: 10.1038/s12276-021-00566-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 01/31/2023] Open
Abstract
Blinding eye diseases such as corneal neovascularization, proliferative diabetic retinopathy, and age-related macular degeneration are driven by pathological angiogenesis. In cancer, angiogenesis is key for tumor growth and metastasis. Current antiangiogenic treatments applied clinically interfere with the VEGF signaling pathway-the main angiogenic pathway-to inhibit angiogenesis. These treatments are, however, only partially effective in regressing new pathologic vessels, and the disease relapses following cessation of treatment. Moreover, the relapse of pathological angiogenesis can be rapid, aggressive and more difficult to treat than angiogenesis in the initial phase. The manner in which relapse occurs is poorly understood; however, recent studies have begun to shed light on the mechanisms underlying the revascularization process. Hypotheses have been generated to explain the rapid angiogenic relapse and increased resistance of relapsed disease to treatment. In this context, the present review summarizes knowledge of the various mechanisms of disease relapse gained from different experimental models of pathological angiogenesis. In addition, the basement membrane-a remnant of regressed vessels-is examined in detail to discuss its potential role in disease relapse. Finally, approaches for gaining a better understanding of the relapse process are discussed, including prospects for the management of relapse in the context of disease.
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Harper CA, Beck KD, Chang E, Young R, Moshfeghi DM. Playing With Fire. Ophthalmic Surg Lasers Imaging Retina 2020; 51:542-544. [PMID: 33104220 DOI: 10.3928/23258160-20201005-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022]
Abstract
The authors present their concerns surrounding data presented in studies from 2018 and 2020 regarding very low dose bevacizumab for the treatment of retinopathy of prematurity. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:542-544.].
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Singh SR, Katoch D, Handa S, Kaur S, Moharana B, Dogra M, Dogra MR. Safety and efficacy of 532 nm frequency-doubled Nd-YAG green laser photocoagulation for treatment of retinopathy of prematurity. Indian J Ophthalmol 2019; 67:860-865. [PMID: 31124503 PMCID: PMC6552620 DOI: 10.4103/ijo.ijo_325_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of 532 nm frequency-doubled Nd-YAG green laser for treatment of retinopathy of prematurity (ROP). Methods This retrospective interventional case series included infants undergoing treatment for ROP with 532 nm green laser between January 2012 and March 2017 at a single tertiary-care referral center. Review of clinical records was done to identify baseline ROP characteristics, procedural difficulties, complications related to the laser procedure and outcome of treatment at ≥ 1 year of follow-up. Results There are about 347 eyes of 182 infants were included in this present study. ROP presented in zone I in 76 eyes (21.9%) and zone II in 271 eyes (78.1%). Tunica vasculosa lentis (TVL) was present in 43.8% and pre-existing vitreous hemorrhage in 4.6% of the eyes. 532 nm green laser could be performed as a primary procedure in all eyes, including those with TVL. 322 eyes completed a minimum follow up of 1 year with a mean follow up of 22.8 months (range, 12-54 months). At the last follow-up visit, 298 (92.5%) of the 322 eyes had a favorable outcome. On logistic regression analysis, pre-existing fibrovascular proliferation (p = 0.04) and new-onset fibrovascular proliferation after treatment (p = 0.001) were the most significant independent predictors of poor outcome. Complications encountered were new-onset hemorrhage in 36 eyes (11.2%), anterior segment ischemia in two eyes (0.006%) and cataract in one eye (0.003%). Conclusion 532 nm frequency-doubled Nd-YAG green laser appears to be safe and effective in the treatment of ROP.
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Affiliation(s)
- Simar Rajan Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sabia Handa
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Savleen Kaur
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bruttendu Moharana
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mangat R Dogra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Goyal A, Giridhar A, Gopalakrishnan M, Thachil T. Neonatal Intensive Care Unit-based screening program for retinopathy of prematurity and its treatment in an Indian population. Indian J Ophthalmol 2019; 67:828-833. [PMID: 31124496 PMCID: PMC6552612 DOI: 10.4103/ijo.ijo_201_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: The purpose was to study the incidence, risk factors, and anatomical outcomes after laser treatment in retinopathy of prematurity (ROP). Methods: A retrospective observational study was carried out. Infants admitted to Neonatal Intensive Care Unit of 12 referral hospitals between April 2016 and September 2017 were screened according to the latest Indian guidelines based on the International Classification of Retinopathy of Prematurity. Results: The incidence of ROP in 1648 eyes screened was 25.36% (418 eyes), out of which high-risk prethreshold ROP (type 1) was observed in 9.95% (164 eyes). Decreased hemoglobin (P < 0.001), oxygen requirement (P = 0.008), and number of blood transfusions (P = 0.037) were significant with type 1 than type 2 (low-risk prethreshold) ROP. Stages 1, 2, and 3 were observed in 82 (32.28%), 154 (60.62%), and 18 (7.08%) eyes, respectively. Aggressive posterior ROP (APROP) was observed in 20.73% eyes with type 1 ROP. Ten eyes showing APROP were treated at an early gestational age of 29 weeks. All infants with type 1 ROP were treated with laser photocoagulation only. Conclusion: One-fourth of the infants showed ROP and one-tenth needed laser photocoagulation, the outcome of which was excellent. Risk factors predisposing to ROP were anemia, high oxygen supplementation, increased number of blood transfusions, and septicemia. ROP screening in infants ≥1700 g birth weight associated with various systemic risk factors may be beneficial in the Indian population.
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Affiliation(s)
- Anubhav Goyal
- Department of Vitreo-Retina, Giridhar Eye Institute, Kochi, Kerala, India
| | | | | | - Thomas Thachil
- Department of Vitreo-Retina, Giridhar Eye Institute, Kochi, Kerala, India
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Walz JM, Bemme S, Reichl S, Akman S, Breuß H, Süsskind D, Glitz B, Müller VC, Wagenfeld L, Gabel-Pfisterer A, Aisenbrey S, Engelmann K, Koutsonas A, Krohne TU, Stahl A. [Treated cases of retinopathy of prematurity in Germany : 5-year data from the Retina.net ROP registry]. Ophthalmologe 2019; 115:476-488. [PMID: 29637302 DOI: 10.1007/s00347-018-0701-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is one of the main reasons for childhood blindness. The number of infants requiring treatment, however, is low for individual centers. The Retina.net ROP registry has been founded to allow a joint analysis of treatment patterns and courses post treatment. OBJECTIVE This paper reports treatment patterns over 5 years. MATERIAL AND METHODS All infants born between January 2011 and December 2015 who were entered into the treatment registry by one of the 12 participating centers were analyzed. RESULTS The data of 150 infants (292 eyes) were analyzed and ROP 3+ in zone II was the most prevalent treatment indication. Gestational age and birth weight remained stable over the years. The treatment patterns, however, changed with anti-VEGF treatment (bevacizumab or ranibizumab) accounting for only 10% of treated eyes in 2011 but for 56% and 30% in 2014 and 2015, respectively. Almost all eyes with AP-ROP or zone I disease received anti-VEGF treatment. Zone II disease was predominantly treated with laser photocoagulation. Recurrences were more common and appeared later in the anti-VEGF group compared to the laser group (23%/interval 60 days vs. 17%/interval 23 days). Perioperative complications were evenly distributed across treatment groups. CONCLUSION The data in this analysis represent about 10-15% of treated infants in Germany. The results provide evidence for an increasing use of anti-VEGF agents for ROP. The data reflect a selection bias for anti-VEGF treatment in eyes with a more aggressive disease. This needs to be considered when interpreting data such as disease recurrence rates. The risk for late recurrences after anti-VEGF treatment is of particular clinical significance.
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Affiliation(s)
- J M Walz
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.,Fakultät für Chemie und Pharmazie, Lehrstuhl Pharmakologie und Toxikologie, Universität Regensburg, Regensburg, Deutschland.,European Foundation for the Care of Newborn Infants (EFCNI), München, Deutschland
| | - S Bemme
- Klinik für Augenheilkunde, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - S Reichl
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - S Akman
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - H Breuß
- Klinik für Augenheilkunde, HELIOS Klinikum Berlin-Buch, Berlin, Deutschland
| | - D Süsskind
- Universitäts-Augenklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - B Glitz
- Klinik für Augenheilkunde, Universität Münster, Münster, Deutschland
| | - V C Müller
- Klinik für Augenheilkunde, Universität Münster, Münster, Deutschland
| | - L Wagenfeld
- Klinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - A Gabel-Pfisterer
- Klinik für Augenheilkunde, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - S Aisenbrey
- Klinik für Augenheilkunde, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - K Engelmann
- Klinik für Augenheilkunde, Klinikum Chemnitz gGmbH, Chemnitz, Deutschland
| | - A Koutsonas
- Klinik für Augenheilkunde, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - T U Krohne
- Universitäts-Augenklinik Bonn, Bonn, Deutschland
| | - A Stahl
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
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Zhang T, Sun X, Han J, Han M. Genetic variants of TSPAN12 gene in patients with retinopathy of prematurity. J Cell Biochem 2019; 120:14544-14551. [PMID: 31009104 DOI: 10.1002/jcb.28715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/19/2019] [Accepted: 02/28/2019] [Indexed: 11/10/2022]
Abstract
Genetic susceptibility to retinopathy of prematurity (ROP) has been reported. However, no virulence genes are currently known for ROP. This study aimed to assess FZD4, LRP5, TSPAN12, and NDP, which are known virulence genes involved in familial exudative vitreoretinopathy, an ailment that shares some symptoms with ROP. After approval from the parents of diseased infants, blood samples from 29 Han patients with ROP were collected for genomic DNA extraction. Direct sequencing was used to assess the four candidate genes, namely FZD4, LRP5, TSPAN12, and NDP. Finally, genetic mutations were screened. Changes of three nucleotide sequences were found in the four candidate genes; notably, a c.954G>A hybrid mutation in the TSPAN12 gene was predicted to cause protein structure and function alterations. The molecular pathogenesis of ROP is complex, and likely involves the c.954G>A mutation in TSPAN12.
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Affiliation(s)
- Tongmei Zhang
- Clinical College of Ophthalmology, Tianjin Eye Hospital, Tianjin Medical University, TianJin, PR China
| | - Xiaoli Sun
- Clinical College of Ophthalmology, Tianjin Eye Hospital, Tianjin Medical University, TianJin, PR China
| | - Junlin Han
- Clinical College of Ophthalmology, Tianjin Eye Hospital, Tianjin Medical University, TianJin, PR China
| | - Mei Han
- Clinical College of Ophthalmology, Tianjin Eye Hospital, Tianjin Medical University, TianJin, PR China
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Chen W, Zhang J, Zhang P, Hu F, Jiang T, Gu J, Chang Q. Role of TLR4-MAP4K4 signaling pathway in models of oxygen-induced retinopathy. FASEB J 2019; 33:3451-3464. [PMID: 30475644 DOI: 10.1096/fj.201801086rr] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Retinopathy of prematurity is a vision-threatening condition, and therapies based on antagonizing VEGF may elicit serious side effects in premature infants. Mechanisms of retinal angiogenesis, particularly the signaling pathways independent of VEGF, remain elusive. The goals of our study were to explore TLR4-mediated signaling pathways in human retinal microvascular endothelial cells (HRMECs) and to examine the effects of TLR4 antagonists in models of oxygen-induced retinopathy (OIR). Our results show that intravitreal injection of the TLR4 antagonist TAK-242 reduced areas of nonperfusion, inhibited aberrant angiogenesis, and improved vascular density in the retina of OIR mice. The effects were further potentiated by the anti-VEGF antibody ranibizumab. In cultured HRMECs, the TLR4 agonist LPS up-regulated TLR4/MAPKK kinase kinase 4 (MAP4K4) signaling, and promoted cell proliferation and migration, and reduced barrier functions of the cells. Down-regulation of MAP4K4 in HRMECs abolished the proangiogenic effects by LPS. Our data suggest that the TLR4-MAP4K4 pathway can regulate retinal neovascularization via mechanisms independent of VEGF.-Chen, W., Zhang, J., Zhang, P., Hu, F., Jiang, T., Gu, J., Chang, Q. Role of TLR4-MAP4K4 signaling pathway in models of oxygen-induced retinopathy.
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Affiliation(s)
- Wenwen Chen
- Department of Ophthalmology and Vision Science, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Juan Zhang
- Department of Ophthalmology and Vision Science, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Peijun Zhang
- Department of Ophthalmology and Vision Science, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Fangyuan Hu
- Department of Ophthalmology and Vision Science, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Tingting Jiang
- Department of Ophthalmology and Vision Science, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Junxiang Gu
- Department of Ophthalmology and Vision Science, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Qing Chang
- Department of Ophthalmology and Vision Science, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
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Norman M, Hellström A, Hallberg B, Wallin A, Gustafson P, Tornqvist K, Håkansson S, Holmström G. Prevalence of Severe Visual Disability Among Preterm Children With Retinopathy of Prematurity and Association With Adherence to Best Practice Guidelines. JAMA Netw Open 2019; 2:e186801. [PMID: 30646195 PMCID: PMC6324320 DOI: 10.1001/jamanetworkopen.2018.6801] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE Retinopathy of prematurity (ROP) can cause severe visual disability even in high-resource settings. A better understanding of the prevalence and processes leading to ROP-induced severe visual impairment may help health care professionals design preventive measures. OBJECTIVES To determine the prevalence of severe visual disability among children born preterm in Sweden, evaluate adherence to best practice, and determine the health system's structural capacity. DESIGN, SETTING, AND PARTICIPANTS Population-based, nationwide cohort study of 1 310 227 children born between January 1, 2004, and December 31, 2015, in Sweden, of whom 17 588 (1.3%) were born very preterm (<32 weeks of gestation). Children born preterm with a verified diagnosis of severe visual disability had their medical records reviewed for evaluation of ROP screening, diagnosis, and treatment. In addition, a questionnaire on structural capacity was sent to all ophthalmology departments. EXPOSURES Stages 4 and 5 ROP. MAIN OUTCOMES AND MEASURES The primary outcome was prevalence of severe visual disability (visual acuity ≤20/200 for both eyes) associated with ROP stages 4 and 5. Secondary outcomes included adherence to national ROP guidelines using a predefined protocol with 15 key performance indicators for screening, diagnosis, and treatment; assessment of whether visual disability was deemed avoidable; and examination of structural capacity, including information on equipment and facilities, staffing, and patients. RESULTS Seventeen children (10 boys; mean [range] birth weight, 756 [454-1900] g; mean [range] gestational age, 25 [22-33] weeks) became severely visually disabled because of ROP, corresponding to a prevalence of 1 in 1000 very preterm infants (<32 weeks of gestational age) and 1 in 77 000 for all live births. Severe visual impairment was considered potentially avoidable in 11 of 17 affected children (65%) owing to untimely or no screening, missed diagnosis, or untimely and suboptimal treatment. Large variations in infrastructure (facilities, guidelines, staffing, and annual patient numbers) were also identified as potential contributors to these findings. CONCLUSIONS AND RELEVANCE Retinopathy of prematurity still causes severe visual disability in Sweden, resulting in 1 affected infant per 1000 very preterm births. In most of these infants, noncompliance with best practice was identified, indicating that a significant proportion could have been avoided.
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Affiliation(s)
- Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Swedish Neonatal Quality Registry, Umeå, Sweden
| | - Ann Hellström
- Department of Ophthalmology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Boubou Hallberg
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta Wallin
- Department of Pediatric Ophthalmology and Strabismus, St Erik Eye Hospital, Stockholm, Sweden
| | | | - Kristina Tornqvist
- Department of Clinical Sciences, Ophthalmology, Lund University, Lund, Sweden
| | - Stellan Håkansson
- Swedish Neonatal Quality Registry, Umeå, Sweden
- Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
| | - Gerd Holmström
- Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
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Aldebasi T, Guma MA, Bashir R, Al Saif S, Altwaijri WA, Al Bekairy AM. Intravitreal Ranibizumab Injection for the Treatment of Retinopathy of Prematurity. Med Princ Pract 2019; 28:526-532. [PMID: 30995663 PMCID: PMC6944941 DOI: 10.1159/000500310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/14/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy of a single injection of 0.3 mg intravitreal ranibizumab for the treatment of retinopathy of prematurity (ROP). METHODS We conducted this retrospective case series study at King Abdul Aziz Medical City, Riyadh, Saudi Arabia. Seventy-four eyes of 37 preterm infants with ROP stage III with plus disease in zone I, posterior zone II, and aggressive posterior ROP received a single injection of 0.3 mg intravitreal ranibizumab. The favorable outcome measure was complete regression of the disease with normal vascularization of the retina of those infants. RESULTS The gestational age of the 37 included cases was in the range of 23-28 weeks and their body weight at birth was between 510 and 1,235 g except for one case with 2,550 g under oxygen therapy <7days with severe hypoglycemia. All eyes showed a favorable response in terms of regression of plus disease from the first day after treatment, followed by regression of stage III retinopathy. All patients developed complete vascularization over variable periods of time. CONCLUSION One injection of 0.3 mg intravitreal ranibizumab is effective in treating ROP stage III mainly in zones I and II.
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Affiliation(s)
- Tariq Aldebasi
- Division of Ophthalmology, Department of Surgery, King Abdul Aziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Muataz A Guma
- Division of Ophthalmology, Department of Surgery, King Abdul Aziz Medical City, Riyadh, Saudi Arabia
| | - Rabia Bashir
- Division of Ophthalmology, Department of Surgery, King Abdul Aziz Medical City, Riyadh, Saudi Arabia
| | - Saif Al Saif
- Neonatal Intensive Care Department, King Abdul Aziz Medical City, Riyadh, Saudi Arabia
| | - Waleed A Altwaijri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia
- Neonatal Intensive Care Department, King Abdul Aziz Medical City, Riyadh, Saudi Arabia
| | - Abdulkareem M Al Bekairy
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia,
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Functional and Structural Outcomes of Temporal Zone II-Sparing Laser Photocoagulation Combined with Intravitreal Bevacizumab in Retinopathy of Prematurity. J Ophthalmol 2018; 2018:2376240. [PMID: 30363696 PMCID: PMC6180920 DOI: 10.1155/2018/2376240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/29/2018] [Accepted: 07/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background/Aim The aim of the study was to investigate the outcomes of temporal Zone II-sparing laser photocoagulation combined with intravitreal bevacizumab (IVB) in patients with Type 1 retinopathy of prematurity (ROP) in Zone I. Methods Medical records of 74 eyes of 37 infants were analysed. Only infants with Type 1 ROP in Zone I were included. Thirty-two eyes were treated with temporal-sparing laser + IVB. Both Zone I and temporal Zone II were spared to minimise potential visual field loss. Forty-two eyes were treated with laser alone conventionally. Early treatment outcomes, late complications, and refractive errors were analysed. Results The mean gestational age and birth weight of the enrolled patients were 25.7 ± 2.5 weeks and 798.8 ± 440.2 g, respectively. In the combined treatment group, plus sign regression was achieved faster (12.1 ± 6.2 days vs. 25.6 ± 21.3 days, p=0.011) and retreatment was required less (0% vs. 23.8%, p=0.004) than in the laser-alone group. Retinal/preretinal haemorrhages occurred more often in the laser-alone group (42.9% vs. 9.4%, p=0.002). Normal development of temporal retinal vessels was also observed in twelve eyes in the combined treatment group. No differences in late complications or refractive errors were observed between the groups. Conclusion Temporal Zone II-sparing laser treatment combined with IVB showed good early treatment outcome and temporal retinal vessels development.
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Arámbulo O, Dib G, Iturralde J, Brito M, Fortes Filho JB. Analysis of the Recurrence of Plus Disease after Intravitreal Ranibizumab as a Primary Monotherapy for Severe Retinopathy of Prematurity. ACTA ACUST UNITED AC 2018; 2:858-863. [DOI: 10.1016/j.oret.2017.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/10/2017] [Accepted: 11/17/2017] [Indexed: 11/25/2022]
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Refractive and Biometric Outcomes in Patients with Retinopathy of Prematurity Treated with Intravitreal Injection of Ranibizumab as Compared with Bevacizumab: A Clinical Study of Correction at Three Years of Age. J Ophthalmol 2018; 2018:4565216. [PMID: 29713524 PMCID: PMC5866885 DOI: 10.1155/2018/4565216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/14/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To compare refractive and biometric outcomes in patients with type 1 retinopathy of prematurity (ROP) treated with intravitreal injection of ranibizumab (IVR) versus bevacizumab (IVB), at a corrected age of 3 years. Methods A retrospective case series compared cycloplegic refractive statuses and biometric statuses in patients who received either IVR or IVB for type 1 ROP, from April 2011 to April 2014. Results A total of 62 eyes (33 patients) with type 1 ROP were evaluated (26 eyes in 13 IVR patients and 36 eyes in 20 IVB patients). There were no differences in birth statuses including gestational age and birth body weight between the two groups. The prevalence of refractive error greater than 1 D was higher in the IVB group (p = 0.03), and there was a higher prevalence of high myopia (<-5.0 D, p = 0.03) in the IVB group. Comparisons in biometric finding showed that IVB patients had shallower anterior chamber depth (p = 0.01). Conclusion Both IVR and IVB showed low refractive errors, even followed at the corrected age of 3 years. No difference was noted between the two groups in refractive statuses. However, IVB was associated with shallower anterior chamber and higher prevalence of refractive error at the corrected age of 3 years. This trial is registered with NCT03334513.
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Stahl A, Krohne TU, Eter N, Oberacher-Velten I, Guthoff R, Meltendorf S, Ehrt O, Aisenbrey S, Roider J, Gerding H, Jandeck C, Smith LEH, Walz JM. Comparing Alternative Ranibizumab Dosages for Safety and Efficacy in Retinopathy of Prematurity: A Randomized Clinical Trial. JAMA Pediatr 2018; 172:278-286. [PMID: 29309486 PMCID: PMC5840003 DOI: 10.1001/jamapediatrics.2017.4838] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Anti-vascular endothelial growth factor (VEGF) therapies are a novel treatment option in retinopathy of prematurity (ROP). Data on dosing, efficacy, and safety are insufficient. OBJECTIVE To investigate lower doses of anti-VEGF therapy with ranibizumab, a substance with a significantly shorter systemic half-life than the standard treatment, bevacizumab. DESIGN, SETTING, AND PARTICIPANTS This randomized, multicenter, double-blind, investigator-initiated trial at 9 academic medical centers in Germany compared ranibizumab doses of 0.12 mg vs 0.20 mg in infants with bilateral aggressive posterior ROP; ROP stage 1 with plus disease, 2 with plus disease, or 3 with or without plus disease in zone I; or ROP stage 3 with plus disease in posterior zone II. Patients were recruited between September 2014 and August 2016. Twenty infants were screened and 19 were randomized. INTERVENTIONS All infants received 1 baseline ranibizumab injection per eye. Reinjections were allowed in case of ROP recurrence after at least 28 days. MAIN OUTCOMES AND MEASURES The primary end point was the number of infants who did not require rescue therapy at 24 weeks. Key secondary end points included time-to-event analyses, progression of physiologic vascularization, and plasma VEGF levels. Stages of ROP were photodocumented and reviewed by an expert committee. RESULTS Nineteen infants with ROP were enrolled (9 [47.4%] female; median [range] postmenstrual age at first treatment, 36.4 [34.7-39.7] weeks), 3 of whom died during the study (1 in the 0.12-mg group and 2 in the 0.20-mg group). Of the surviving infants, 8 (88.9%) (17 eyes [94.4%]) in the 0.12-mg group and 6 (85.7%) (13 eyes [92.9%]) in the 0.20-mg group did not require rescue therapy. Both ranibizumab doses were equally successful in controlling acute ROP (Cochran-Mantel-Haenszel analysis; odds ratio, 1.88; 95% CI, 0.26-13.49; P = .53). Physiologic intraretinal vascularization was superior in the 0.12-mg group. The VEGF plasma levels were not systematically altered in either group. CONCLUSIONS AND RELEVANCE This pilot study demonstrates that ranibizumab is effective in controlling acute ROP and that 24% of the standard adult dose (0.12 mg) appears equally effective as 40% (0.20 mg). Superior vascularization of the peripheral retina with 0.12 mg of ranibizumab indicates that the lower dose may be favorable. Unchanged plasma VEGF levels point toward a limited systemic drug exposure after ranibizumab. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02134457 and clinicaltrialsregister.eu Identifier: 2013-002539-13.
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Affiliation(s)
- Andreas Stahl
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tim U. Krohne
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | | | - Rainer Guthoff
- Department of Ophthalmology, Faculty of Medicine, University of Dusseldorf, Dusseldorf, Germany
| | - Synke Meltendorf
- Department of Ophthalmology, Otto von Guericke University, Magdeburg, Germany
| | - Oliver Ehrt
- Department of Ophthalmology, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Sabine Aisenbrey
- University Eye Hospital, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Johann Roider
- Department of Ophthalmology, University of Kiel, University Medical Center, Kiel, Germany
| | | | | | - Lois E. H. Smith
- Department of Ophthalmology, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts
| | - Johanna M. Walz
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
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Sternberg P, Durrani AK. Evolving Concepts in the Management of Retinopathy of Prematurity. Am J Ophthalmol 2018; 186:xxiii-xxxii. [PMID: 29109051 DOI: 10.1016/j.ajo.2017.10.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE The introduction of anti-vascular endothelial growth factor (VEGF) agents has stimulated considerable reexamination of treatment strategies for the management of retinopathy of prematurity (ROP). Herein we summarize and review evolving concepts and provide a personal perspective on clinical management today and future directions of treatment. DESIGN Literature review. METHODS To synthesize the evolving management concepts for diagnosis and treatment of retinopathy of prematurity and to provide interpretation and perspective on current emerging therapies. RESULTS Although initial treatment strategies focused on ablative therapy for threshold ROP, earlier treatment for type 1 or pre-threshold disease has been found to decrease unfavorable visual and structural outcomes. Vascular endothelial growth factor has emerged as a significant contributor to retinal-vascular diseases in the previous 2 decades. The potential role of anti-VEGF treatment for type 1 ROP has become a focus in recent years, but the protracted recurrence of disease and unknown adverse ocular and systemic effects have caused concern from some clinicians. In addition, the use of telemedicine technologies may provide the ability to screen remote areas with a shortage of ROP providers, thereby reducing the burden of disease. CONCLUSIONS The diagnosis and management of ROP has changed over the past 40 years; the role of anti-VEGF therapy remains to be established in current treatment strategies. Screening for initial disease and progression will likely be impacted by the increasing prevalence of telemedicine and relative shortage of clinicians.
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Chan-Ling T, Gole GA, Quinn GE, Adamson SJ, Darlow BA. Pathophysiology, screening and treatment of ROP: A multi-disciplinary perspective. Prog Retin Eye Res 2017; 62:77-119. [PMID: 28958885 DOI: 10.1016/j.preteyeres.2017.09.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 12/24/2022]
Abstract
The population of infants at risk for retinopathy of prematurity (ROP) varies by world region; in countries with well developed neonatal intensive care services, the highest risk infants are those born at less than 28 weeks gestational age (GA) and less than 1 kg at birth, while, in regions where many aspects of neonatal intensive and ophthalmological care are not routinely available, more mature infants up to 2000 g at birth and 37 weeks GA are also at risk for severe ROP. Treatment options for both groups of patients include standard retinal laser photocoagulation or, more recently, intravitreal anti-VEGF drugs. In addition to detection and treatment of ROP, this review highlights new opportunities created by telemedicine, where screening and diagnosis of ROP in remote locations can be undertaken by non-ophthalmologists using digital fundus cameras. The ophthalmological care of the ROP infant is undertaken in the wider context of neonatal care and general wellbeing of the infant. Because of this context, this review takes a multi-disciplinary perspective with contributions from retinal vascular biologists, pediatric ophthalmologists, an epidemiologist and a neonatologist. This review highlights the latest insights regarding cellular and molecular mechanisms in the formation of the retinal vasculature in the human infant, pathogenesis of ROP, detection and treatment of severe ROP, the risks and benefits of anti-VEGF therapy, the identification of new therapies over the horizon, and the optimal neonatal care regimen for best ROP outcomes, and the benefits and pitfalls of telemedicine in the remote screening and diagnosis of ROP, all of which have the potential to improve ROP outcomes.
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Affiliation(s)
- Tailoi Chan-Ling
- Department of Anatomy, School of Medical Sciences and Bosch Institute, University of Sydney, NSW 2006, Australia.
| | - Glen A Gole
- Discipline of Paediatrics and Child Health, University of Queensland, Qld Children's Hospital, Sth Brisbane, Qld 4101, Australia.
| | - Graham E Quinn
- Division of Ophthalmology, The Children's Hospital of Philadelphia and Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Samuel J Adamson
- Department of Anatomy, School of Medical Sciences and Bosch Institute, University of Sydney, NSW 2006, Australia
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, New Zealand.
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Abstract
PURPOSE OF REVIEW Currently, severe retinopathy of prematurity (ROP) is diagnosed by clinical evaluation and not a laboratory test. Laser is still considered standard care. However, anti-vascular endothelial growth factor (VEGF) agents are being used and there are questions whether and/or if to use them, what dose or type of agent should be considered and what agent may be most beneficial in specific cases. Also unclear are the effects of laser or anti-VEGF on severe ROP, refractive outcomes or infant development. This article reviews recent studies related to these questions and other trials for severe ROP. RECENT FINDINGS Imaging studies identify biomarkers of risk (plus disease, stage 3 ROP, and ROP in zone I). Intravitreal bevacizumab or ranibizumab are reported effective in treating aggressive posterior ROP in small series. Recurrences and effects on myopia vary among studies. Use of anti-VEGF agents affects cytokines in the infant blood and reduces systemic VEGF for up to 2 months, raising potential safety concerns. The effects of treatment vary based on infant size and are not comparable. Evidence for most studies is not high. SUMMARY Studies support experimental evidence that inhibiting VEGF reduces stage 3 ROP and peripheral avascular retina. Ongoing large-scale clinical trials may provide clarity for best treatments of severe ROP. Current guidelines hold for screening and treatment for type 1 ROP.
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Fernandez MP, Berrocal AM, Goff TC, Ghassibi MP, Harper CA, Chou E, Michael SK, Hellman J, Dubovy SR. Histopathologic Characterization of the Expression of Vascular Endothelial Growth Factor in a Case of Retinopathy of Prematurity Treated With Ranibizumab. Am J Ophthalmol 2017; 176:134-140. [PMID: 27993591 DOI: 10.1016/j.ajo.2016.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To characterize the expression of vascular endothelial growth factor (VEGF) in a patient with retinopathy of prematurity (ROP) treated with ranibizumab (Case 1) and compare it with a case of ROP without treatment (Case 2), a case of a premature baby without ROP (Case 3), and a case of a baby without history of ROP or prematurity (Case 4). DESIGN Observational case series. METHODS The eyes of the deceased babies were removed postmortem and were sent to the Florida Lions Ocular Pathology Laboratory, where they were processed. The specimens were immunostained using an antibody against VEGF. RESULTS All eyes except for the eyes in Case 4 disclosed positive VEGF staining. Positive staining was present within the nerve fiber layer, inner plexiform layer, and inner and outer nuclear layers and within the spindle-shaped cell population in the vanguard in Case 1. In the posterior pole, positive staining was only observed at the level of the nerve fiber layer. This case also demonstrated less positive staining when compared with Case 2, where positive staining was found within all layers of the retina. CONCLUSION Less VEGF staining was observed within the retina of the eyes treated with ranibizumab when compared with the VEGF staining in Case 2. This supports the idea that anti-VEGF agents are effective in reducing the amount of VEGF present in the retina. Furthermore, the fact that some expression of VEGF remains in the immature retina after injection supports the idea that anti-VEGF agents can suppress uncontrolled neovascularization without completely blocking the vascular drive for the vascularization of the immature retina.
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Affiliation(s)
- Maria P Fernandez
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Audina M Berrocal
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Tyler C Goff
- University of South Carolina School of Medicine Greenville, South Carolina
| | - Mark P Ghassibi
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - C Armitage Harper
- Austin Retina Associates, Austin, Texas; University of Texas Health Science Center, San Antonio, Texas
| | - Eva Chou
- Department of Surgery, Ophthalmology Service, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Simon K Michael
- Newborn Intensive Care Unit & High-Risk Infant Specialty Transport Service, Dell Children's Medical Center, Austin, Texas
| | - Justin Hellman
- Davis Eye Center, University of California, Sacramento, California
| | - Sander R Dubovy
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Chen XK, Ouyang LJ, Yin ZQ, Xia YY, Chen XR, Shi H, Xiong Y, Pi LH. Effects of microRNA-29a on retinopathy of prematurity by targeting AGT in a mouse model. Am J Transl Res 2017; 9:791-801. [PMID: 28337307 PMCID: PMC5340714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/17/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND This study aimed to explore the effects of microRNA-29a (miR-29a) on retinopathy of prematurity (ROP) by targeting angiotensinogen (AGT) expression in a mouse model. METHODS Ninety-six C57BL/6J mice were selected and divided into the normal control group (n = 12) and the oxygen-induced retinopathy (OIR) group (n = 84). All the mice in the OIR group were assigned to the following seven groups (12 mice in each group): the blank, miR-29a mimics, miR-29a inhibitors, empty plasmid, miR-29a mimics + si-AGT, miR-29a inhibitors + si-AGT and si-AGT groups. ADPase histochemical staining was conducted to detect the morphology of retinal neovascularization. H&E staining was performed to quantify retinal neovascularization. The qRT-PCR assay was applied to detect the expression levels of miR-29a and the AGT mRNA. Western blotting was used to detect the protein expressions of AGT, vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), angiotensin (ANG) and angiotensin II (AngII). RESULTS Compared with the normal control group, miR-29a expression decreased, while the AGT mRNA expression and the protein expression levels of AGT, VEGF, HGF, ANG and AngII increased, and retinal vascular density and neovascularization also increased in the OIR group. In the OIR group, compared with the blank, empty plasmid, miR-29a inhibitors and miR-29a inhibitors + si-AGT groups, miR-29a expression increased, while the AGT mRNA expression and protein expression levels of AGT, VEGF, HGF, ANG and AngII decreased, and retinal vascular density and neovascularization also decreased in the miR-29a mimics, miR-29a mimics + si-AGT and si-AGT groups. CONCLUSION MiR-29a could inhibit retinal neovascularization to prevent the development and progression of ROP by down-regulating AGT.
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Affiliation(s)
- Xin-Ke Chen
- Department of Ophthalmology, Children’s Hospital of Chongqing Medical UniversityChongqing 400014, P. R. China
| | - Li-Juan Ouyang
- Department of Ophthalmology, Children’s Hospital of Chongqing Medical UniversityChongqing 400014, P. R. China
| | - Zheng-Qin Yin
- Department of Ophthalmology, Southwest Hospital, Third Military Medical UniversityChongqing 400038, P. R. China
| | - Yuan-You Xia
- Department of Ophthalmology, Children’s Hospital of Chongqing Medical UniversityChongqing 400014, P. R. China
| | - Xiu-Rong Chen
- Department of Ophthalmology, Children’s Hospital of Chongqing Medical UniversityChongqing 400014, P. R. China
| | - Hui Shi
- Department of Ophthalmology, Children’s Hospital of Chongqing Medical UniversityChongqing 400014, P. R. China
| | - Yan Xiong
- Department of Ophthalmology, Children’s Hospital of Chongqing Medical UniversityChongqing 400014, P. R. China
| | - Lian-Hong Pi
- Department of Ophthalmology, Children’s Hospital of Chongqing Medical UniversityChongqing 400014, P. R. China
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Combination of Intravitreal Injection of Ranibizumab and Photocoagulation for the Treatment of Aggressive Posterior Retinopathy of Prematurity with Vitreous Hemorrhage. J Ophthalmol 2016; 2016:5029278. [PMID: 28070414 PMCID: PMC5192312 DOI: 10.1155/2016/5029278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 11/22/2016] [Indexed: 12/22/2022] Open
Abstract
To investigate the efficacy of intravitreal ranibizumab (IVR) combined with laser photocoagulation for aggressive posterior retinopathy of prematurity (AP-ROP) patients with vitreous hemorrhage, we conducted a retrospective observational case series study. A total of 37 eyes of 20 patients' medical records were reviewed. Patients first received IVR (0.25 mg/0.025 mL) and later photocoagulation. The mean postconceptual age of injection was 34.6 ± 1.4 weeks, and the mean follow-up period was 39.3 ± 8.3 weeks. During the follow-up, 96.6% eyes had various degree of rapid absorption of vitreous hemorrhage after IVR. The mean time of received first photocoagulation after IVR was 4.8 ± 2.9 weeks. Ten (27.0%) eyes received second laser therapy and the mean time of second laser therapy after IVR was 3.2 ± 0.8 weeks. All eyes exhibited adequate regression of ROP and were stable with attached retina. Fibrosis membrane was observed in seven eyes (18.9%) and three of them demonstrated mild ectopic macula. No significant side effects related to IVR were observed. So IVR could be conducted as primary treatment of AP-ROP associated with vitreous hemorrhage, which can improve the fundus visibility, followed by conventional photocoagulation. Further randomized controlled trials are necessary to compare the clinical efficacy and safety with conventional interventions.
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