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Kim H, Kim J, Ryu J. Noncoding RNAs as a novel approach to target retinopathy of prematurity. Front Pharmacol 2022; 13:1033341. [PMID: 36386230 PMCID: PMC9641647 DOI: 10.3389/fphar.2022.1033341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/11/2022] [Indexed: 06/21/2024] Open
Abstract
Retinopathy of prematurity (ROP), a vascular disease characterized by abnormal vessel development in the retina, has become a primary cause of blindness in children around the world. ROP can be developed during two different phases: vessel loss and vessel proliferation. Once preterm infants with immature retinal vessel growth are exposed to high level of oxygen inside the incubator, vessel loss can occur. When infants are exposed to room air, they may experience the proliferation of vessels in the retina. Although multiple factors are reported to be involved in the pathogenesis of ROP, including vaso-endothelial growth factors (VEGFs) and hypoxia-inducible factors, the pathogenesis of ROP is not completely understood. Although laser therapy and pharmacologic agents, such as anti-VEGF agents, have been commonly used to treat ROP, the incidence of ROP is rapidly rising. Given that current therapies can be invasive and long-term effects are not fully known, the search for novel therapeutic targets with less destructive properties needs to be considered. Within the last decade, the field of noncoding RNA therapy has shown potential as next-generation therapy to treat diverse diseases. In this review, we introduce various noncoding RNAs regulating ROP and discuss their role as potential therapeutic targets in ROP.
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Affiliation(s)
- Hyunjong Kim
- Vessel-Organ Interaction Research Center, College of Pharmacy, Kyungpook National University, Daegu, South Korea
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
| | - Jaesub Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
| | - Juhee Ryu
- Vessel-Organ Interaction Research Center, College of Pharmacy, Kyungpook National University, Daegu, South Korea
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
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Ryu J. New Aspects on the Treatment of Retinopathy of Prematurity: Currently Available Therapies and Emerging Novel Therapeutics. Int J Mol Sci 2022; 23:ijms23158529. [PMID: 35955664 PMCID: PMC9369302 DOI: 10.3390/ijms23158529] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 02/05/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a rare proliferative ocular disorder in preterm infants. Because of the advancements in neonatal care, the incidence of ROP has increased gradually. Now, ROP is one of the leading causes of blindness in children. Preterm infants with immature retinal development are exposed to supplemental oxygen inside an incubator until their cardiopulmonary system is adequately developed. Once they are returned to room air, the relatively low oxygen level stimulates various angiogenesis factors initiating retinal neovascularization. If patients with ROP are not offered adequate and timely treatment, they can experience vision loss that may ultimately lead to permanent blindness. Although laser therapy and anti-vascular endothelial growth factor agents are widely used to treat ROP, they have limitations. Thus, it is important to identify novel therapeutics with minimal adverse effects for the treatment of ROP. To date, various pharmacologic and non-pharmacologic therapies have been assessed as treatments for ROP. In this review, the major molecular factors involved in the pathogenesis of ROP, currently offered therapies, therapies under investigation, and emerging novel therapeutics of ROP are discussed.
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Affiliation(s)
- Juhee Ryu
- Vessel-Organ Interaction Research Center, College of Pharmacy, Kyungpook National University, Daegu 41566, Korea; ; Tel.: +82-539508583
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Kyungpook National University, Daegu 41566, Korea
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National guideline for ophthalmological screening of premature infants in Germany (S2k level, AWMF guidelines register no. 024/010, March 2020) : Joint recommendation of the German Ophthalmological Society (DOG), German Retina Society (RG), Professional Association of Ophthalmologists in Germany (BVA), German Society of Pediatrics and Adolescent Medicine (DGKJ), Professional Association of Pediatricians (BVKJ), Federal Association "The Premature Infant", Society for Neonatology and Pediatric Intensive Care Medicine (GNPI). DIE OPHTHALMOLOGIE 2022; 119:123-136. [PMID: 35507084 DOI: 10.1007/s00347-022-01632-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 01/25/2023]
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Angiographic findings in cases with a history of severe retinopathy of prematurity treated with anti-VEGFs: Follow-up to age 6 years. Int Ophthalmol 2021; 42:1317-1337. [PMID: 34729633 DOI: 10.1007/s10792-021-02119-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the effects of anti-vascular endothelial growth factor (VEGF) treatment in vascular development for cases of acute retinopathy of prematurity (ROP) using fluorescent angiography (FA) and to present the results of our observational approach to retinal sequelae. METHODS A total of 31 eyes in 19 patients with a history of treatment with anti-VEGF agents for classic type 1 ROP and aggressive posterior ROP who underwent FA between March 2014 to February 2020 were reviewed. Angiograms of retinal developmental features of patients aged 4 months to 6 years were examined. RESULTS The patients mean gestational age were 26.06 ± 1.90 weeks and the mean birth weight were 837.68 ± 236.79 g. All cases showed various abnormalities at the vascular and avascular retina, and the posterior pole. All but one case showed a peripheral avascular area on FA evaluation during the follow-up period. We did not apply prophylactic laser treatment to these avascular retina. On the final examination, except one case, we did not observe any late reactivation in any patients. CONCLUSION FA is an important tool for assessing vascular maturation in infants. Every leakage should not be assumed to be evidence of late activation, as some leaks may be related to vascular immaturity. Retinal vascularization may not be completed in all patients, however this does not mean that all these patients need prophylactic laser application. Our observational approach may be more daring than the reports frequently encountered in the literature, but it should be noted that unnecessary laser treatment will also eliminate all the advantages of anti-VEGF treatment.
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Simmons M, Wang J, Leffler JN, Li S, Morale SE, de la Cruz A, Birch EE. Longitudinal Development of Refractive Error in Children Treated With Intravitreal Bevacizumab or Laser for Retinopathy of Prematurity. Transl Vis Sci Technol 2021; 10:14. [PMID: 34003992 PMCID: PMC8054622 DOI: 10.1167/tvst.10.4.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose To compare the patterns of longitudinal refractive error development during the first 3.5 years in children with severe retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB) or laser photocoagulation. Methods This prospective cohort study enrolled extremely preterm infants (birth weight < 1000 g, gestational age 23-27 weeks) with type 1 ROP from multiple hospitals in Dallas between 1999 and 2017; IVB group (N = 22); laser group (N = 26). Cycloplegic retinoscopy was conducted from 0.04 years corrected age and every 0.5 to 1.0 years thereafter until 3.5 years old. Right eye spherical equivalent (SEQ) and astigmatism, anisometropia, and better-eye visual acuity were analyzed over time. Results In all children, both eyes were treated with the same modality. At the final visit, the prevalence of myopia (SEQ ≤ -1D) was 82.7% in the laser group and 47.7% in the IVB group (P < 0.05) with a mean SEQ of -8.0D ± 5.8D in the laser group versus -2.3D ± 4.2D in the IVB group (P < 0.001). Longitudinal SEQ were best fit with a bilinear model. Before one year, the rate of SEQ change was -5.0D/year in the laser group, but only -3.5D/year in the IVB group (T = -5.14, P < 0.001); after one year, there was a significant flattening of these slopes (T = 6.23, P < 0.001). Anisometropia in the IVB group was significantly less than in the laser group (P < 0.05). Final visual acuity in both groups was similar at 0.47 logMAR (∼ 20/60). Conclusions Children with severe ROP treated with IVB developed less myopic refractive error than those treated with laser largely because of a slower rate of refractive change during the first year of life. Translational Relevance These findings may inform decisions regarding ROP treatment timing and modality.
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Affiliation(s)
- Michael Simmons
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jingyun Wang
- SUNY College of Optometry, State University of New York, New York, NY, USA
| | - Joel N Leffler
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shanshan Li
- MassMutual Data Science, Springfield, MA, USA
| | | | | | - Eileen E Birch
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Retina Foundation of the Southwest, Dallas, TX, USA
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Ekinci DY, Vural AD. Comparison of two different doses of intravitreal aflibercept in the treatment of retinopathy of prematurity. J AAPOS 2021; 25:93.e1-93.e5. [PMID: 33905838 DOI: 10.1016/j.jaapos.2020.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 10/26/2020] [Accepted: 11/13/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the effectiveness of 0.4 mg/0.01 ml ("low dose") and 1 mg/0.025 ml ("standard dose") intravitreal aflibercept (IVA) in the treatment of retinopathy of prematurity (ROP). METHODS The medical records of patients treated with the lower dose (low-dose group) or the more commonly used dose (standard-dose group) of IVA for type 1 or aggressive posterior retinopathy of prematurity (AP-ROP) were evaluated retrospectively. The clinical features, regression and recurrence rates, additional treatments, retinal detachment rates and border of vascularization at last examination were analyzed. RESULTS A total of 32 eyes of 16 patients in the low-dose group and 42 eyes of 21 patients in the standard-dose group were included. At the time of the initial treatment, vascularization was in zone I in 26 eyes (81%) in the low-dose group and in 14 eyes (33%) in the standard-dose group (P = 0.000). The regression rate was 94% and 100%, respectively (P = 0.184). Retinal detachment occurred in 1 unresponsive eye in the low-dose group and 2 eyes after reactivation in the standard-dose group. Recurrence was observed in 9 (28%) eyes in the low-dose group and 10 (24%) eyes in the standard-dose group after the complete regression of the disease with treatment (P = 0.845). At 6 months, vascularization had entered zone III in 12 eyes (38%) in the low-dose group and in 24 eyes (57%) in the standard-dose group (P = 0.017). CONCLUSIONS Although the difference between groups was not statistically significant, eyes with lack of response were present only in the low-dose group.
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Affiliation(s)
- Dilbade Yildiz Ekinci
- Department of Ophthalmology, Diyarbakir Gazi Yasargil Training and Research Hospital, Turkey.
| | - Asli Deger Vural
- Department of Ophthalmology Istanbul Bakirkoy Sadi Konuk Training and Research Hospital, Turkey
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[Guidelines for ophthalmological screening of premature infants in Germany (S2k level, AWMF guidelines register no. 024/010, March 2020) : Joint recommendation of the German Ophthalmological Society (DOG), Retinological Society (RG), Professional Association of Ophthalmologists in Germany e. V. (BVA), German Society of Paediatrics and Adolescent Medicine (DGKJ), Professional Association of Pediatricians (BVKJ), Federal Association "The Premature Child" , Society for Neonatology and Paediatric Intensive Care Medicine (GNPI)]. Ophthalmologe 2021; 118:117-131. [PMID: 33694101 DOI: 10.1007/s00347-021-01353-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 12/20/2022]
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Maier RF, Hummler H, Kellner U, Krohne TU, Lawrenz B, Lorenz B, Mitschdörfer B, Roll C, Stahl A. Augenärztliche Screening-Untersuchung bei Frühgeborenen (S2k-Level, AWMF-Leitlinien-Register-Nr. 024/010, März 2020). Z Geburtshilfe Neonatol 2021; 225:19-33. [PMID: 33450782 DOI: 10.1055/a-1248-0649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Rolf F Maier
- Zentrum für Kinder- und Jugendmedizin Marburg, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg
| | | | - Ulrich Kellner
- Augenzentrum Siegburg, MVZ Augenärztliches Diagnostik- und Therapiecentrum Siegburg GmbH
| | | | - Burkhard Lawrenz
- Privatpraxis für Kinder- und Jugendmedizin Dr. med. Burkhard Lawrenz, Arnsberg
| | - Birgit Lorenz
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität Gießen
| | | | - Claudia Roll
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin, Schlafmedizin, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke
| | - Andreas Stahl
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Greifswald
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Tan QQ, Christiansen SP, Wang J. Development of refractive error in children treated for retinopathy of prematurity with anti-vascular endothelial growth factor (anti-VEGF) agents: A meta-analysis and systematic review. PLoS One 2019; 14:e0225643. [PMID: 31790445 PMCID: PMC6886775 DOI: 10.1371/journal.pone.0225643] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/09/2019] [Indexed: 01/11/2023] Open
Abstract
Objective To investigate refractive error development in preterm children with severe retinopathy of prematurity (ROP) treated with anti-vascular endothelial growth factor (anti-VEGF) agents and laser photocoagulation. Methods Selection criteria were comparative studies that compared the refractive errors in children, birthweights ≤1500 grams and gestational ages ≤30 weeks, and treatments for Type I ROP with intravitreal bevacizumab (IVB) versus laser photocoagulation. Studies were identified using PubMed, Google Scholar, and published reviews. Meta-analyses were performed on the post-treatment outcomes of spherical equivalent (SEQ), cylindrical power, and prevalence of high myopia. Longitudinal development of refractive error in IVB, or in laser-treated children, or in normal full-term children was visually summarized. Results Two randomized controlled trials and 5 non-randomized studies, including a total of 272 eyes treated by IVB and 247 eyes treated by laser, were included in this study. Compared with laser-treated children, IVB-treated children have less myopic refractive error (P<0.001), lower prevalence of high myopia (P<0.05), and less astigmatism (P = 0.02). Conclusions Treatment with IVB is associated with less myopia and astigmatism than laser treatment for infants with severe ROP. Given the complexity of ROP and the variability of dosing, our review supports close monitoring of refractive error outcomes in children treated with IVB.
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Affiliation(s)
- Qing-Qing Tan
- Department of Ophthalmology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
- Department of Ophthalmology and Optometry, North Sichuan Medical College, Nanchong, Sichuan, China
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania, United States of America
| | - Stephen P. Christiansen
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Boston Medical Center, Boston, Massachusetts, United States of America
| | - Jingyun Wang
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania, United States of America
- * E-mail:
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Stahl A. [Review of clinical trials in retinopathy of prematurity : Current state and future perspectives]. Ophthalmologe 2019; 115:456-463. [PMID: 29789899 DOI: 10.1007/s00347-018-0720-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The treatment of retinopathy of prematurity (ROP) has gained a new dynamic since the introduction of anti-vascular endothelial growth factor (VEGF) therapy. This review summarizes clinical trial data in order to aid informed decision-making. METHODS In this article, pivotal clinical trials are summarized and discussed with regard to their implications for ROP therapy. RESULTS The longest follow-up phase exists for children treated in the CRYO-ROP study, which used retinal cryocoagulation to treat ROP. Based on results of the ETROP study and others, retinal laser therapy has replaced cryotherapy as standard of care. For anti-VEGF treatment, three controlled clinical trials exist to date: BEAT-ROP, CARE-ROP, and the PEDIG study. Combined, these studies demonstrate efficacy of anti-VEGF in treating acute ROP. However, they also emphasize the risk of (late) recurrences and the largely unsolved questions regarding choice of drug and dose as well as long-term safety. CONCLUSION Treatment of ROP remains a highly individual decision in which many variables need to be considered. The data discussed in this article can help in decision-making and emphasize the unique characteristics of the available therapeutic approaches, in particular regarding postoperative follow-up.
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Affiliation(s)
- Andreas Stahl
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland.
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Kato A, Okamoto Y, Okamoto F, Saito M, Miyazono Y, Oshika T. Short-term intraocular pressure changes after intravitreal injection of bevacizumab for retinopathy of prematurity. Jpn J Ophthalmol 2019; 63:262-268. [DOI: 10.1007/s10384-019-00661-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 12/21/2018] [Indexed: 11/25/2022]
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Retinopathy of prematurity in the United Kingdom: retreatment rates, visual and structural 1-year outcomes. Eye (Lond) 2018; 32:1752-1759. [PMID: 30013158 PMCID: PMC6224459 DOI: 10.1038/s41433-018-0151-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 06/06/2018] [Indexed: 02/08/2023] Open
Abstract
AIMS To evaluate retreatment rates, visual and anatomical outcomes at 1-year postnatal age in infants treated for retinopathy of prematurity (ROP) METHODS: Longitudinal national surveillance study of infants treated for ROP in the United Kingdom between December 2013 and December 2014, supported by the British Ophthalmic Surveillance Unit. Here we report retreatment rates, anatomical, visual and refractive outcomes at 1-year follow-up. RESULTS One-year follow-up forms were completed for 168 children of the original cohort of 327 (51.4%). Twenty-two had at least one retreatment: 17/153 right eyes (REs, 11.1%) after initial diode laser, and 5/14 REs (35.7%) after initial injection of anti-vascular endothelial growth factor (VEGF) antibody. Median (interquartile range) RE best-corrected visual acuity was 0.6 (0.4-1.0) (n = 46 REs), and median acuity both eyes open 0.4 (0.3-0.7) logMAR (n = 89). Median spherical equivalent (RE) was 0.44 (-1.3 to 1.3) dioptre (D) (n = 116). Median astigmatism (RE) was 0.5 (0-1.0) D (n = 111), and median anisometropia 0.125 (0-0.75) D (n = 116). Twenty-four children (20.5%) had been prescribed glasses. Sight impairment certification eligibility information was available for 131 children: 11 (8.4%) were eligible to be certified as sight impaired, and 5 (3.8%) as severely sight impaired. CONCLUSIONS Retreatment rates are in line with previous reports, and appear higher after initial anti-VEGF antibody than after initial diode laser. Refractive outcomes are in line with previous studies, with a trend towards early emmetropia and myopia following diode laser, particularly in more severe ROP.
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Han J, Kim SE, Lee SC, Lee CS. Low dose versus conventional dose of intravitreal bevacizumab injection for retinopathy of prematurity: a case series with paired-eye comparison. Acta Ophthalmol 2018; 96:e475-e478. [PMID: 27011262 DOI: 10.1111/aos.13004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 01/07/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the clinical outcomes of intravitreal bevacizumab (IVB) injection, with different dosing (0.25 mg/0.01 ml versus 0.625 mg/0.025 ml) in each eye of the same patient with retinopathy of prematurity (ROP). METHODS Intravitreal bevacizumab (IVB) was injected into eight patients with stage 3+ in zone I or posterior zone II ROP (16 eyes). Bevacizumab, with different dosing (0.25 mg/0.01 ml and 0.625 mg/0.025 ml), was injected into the vitreous cavity of each eye. RESULTS Among the 16 eyes treated with IVB, six eyes had zone I ROP and 10 eyes had zone II ROP. The mean birthweight was 800 ± 139 g (range, 533-955 g), and the mean gestational age was 25.9 ± 1.2 gestational weeks (range, 24.4-28.7 weeks). The postmenstrual age at initial treatment was 37.2 gestational weeks (range, 33.7-41 weeks). The mean follow-up was 312 ± 50 days (median, 305 days; range, 238-376 days). All eyes showed regression of plus sign after IVB injection within 1 week and revascularization to the ora serrata at the time of final visit. There was no difference in the time of anatomical achievement between the eyes with different doses. None of the patients received any additional IVB injection or laser photocoagulation. After the regression of ROP, tractional retinal detachment and macular ectopia were not observed in any patients during follow-up. CONCLUSIONS There was no difference in the short-term clinical outcomes of stage 3+ ROP in zone I or II between the eyes with low dose and conventional dose of IVB.
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Affiliation(s)
- Jinu Han
- Institute of Vision Research; Department of Ophthalmology; Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Seong Eun Kim
- Institute of Vision Research; Department of Ophthalmology; Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Sung Chul Lee
- Institute of Vision Research; Department of Ophthalmology; Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Christopher Seungkyu Lee
- Institute of Vision Research; Department of Ophthalmology; Severance Hospital; Yonsei University College of Medicine; Seoul Korea
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Fouzdar Jain S, Song HH, Al-Holou SN, Morgan LA, Suh DW. Retinopathy of prematurity: preferred practice patterns among pediatric ophthalmologists. Clin Ophthalmol 2018; 12:1003-1009. [PMID: 29881255 PMCID: PMC5978463 DOI: 10.2147/opth.s161504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose The treatment of retinopathy of prematurity (ROP) is not standardized and can vary significantly between providers. This study aims to determine preferred practices in treating ROP by globally surveying pediatric ophthalmologists. Methods Between January and February 2017, an international pediatric ophthalmology interest group was invited to complete an anonymous survey of 18 questions. The main objectives were to determine the preferred first line of treatment for ROP, the preferred dosage of intravitreal bevacizumab (IVB) used, and the outcome and possible complications following bevacizumab injection. Results Out of 101 pediatric ophthalmologists, 72 (71.8%) stated that they had direct involvement in the treatment of ROP. When presented with type 1 ROP which requires treatment, 69 ophthalmologists (68.3%) stated that they prefer laser treatment over bevacizumab, and 33 ophthalmologists (32.7%) stated they would recommend bevacizumab as a first choice. Ninety-three ophthalmologists (92.1%) reported the success of 1 laser treatment between 75% and 100%, and 35 ophthalmologists (34.7%) perceive bevacizumab to be 75%–100% successful. Half dose of adult-prescribed bevacizumab at 0.625 mg/0.05 mL was preferred by 47 of the ophthalmologists (46.5%). No cases of endophthalmitis were reported with intravitreal injection. Conclusion Laser photoablation remains the preferred mode of treatment for ROP among surveyed ophthalmologists across the world. Though bevacizumab is currently being used, this form of treatment is not as common, primarily due to the unknown safety profile and potential long-term ramifications of the drug.
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Affiliation(s)
| | - Helen H Song
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shaza N Al-Holou
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Linda A Morgan
- Ophthalmology Department, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Donny W Suh
- Ophthalmology Department, Children's Hospital and Medical Center, Omaha, NE, USA.,Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
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Abstract
Vascular endothelial growth factor (VEGF) is an important mediator of the pathological neovascularization and vascular permeability of the eye. The increasing use of intravitreal therapies targeting VEGF has revolutionized the treatment of pediatric vitreoretinal diseases. In retinopathy of prematurity (ROP), the role of VEGF in pathogenesis has been well recognized and the use of anti-VEGF treatment in phase 2 ROP has demonstrated promising results, particularly in severe cases of posterior disease. This has made VEGF an established target in the treatment of pediatric retinal diseases known to have abnormal vascular activity. However, questions remain about late systemic and neurodevelopmental effects after anti-VEGF therapy for children because intravitreal injection of anti-VEGF may result in systemic circulation of anti-VEGF agent and a corresponding suppression of systemic VEGF. We do not currently know whether the short-term suppression of systemic VEGF affects long-term neurodevelopmental outcomes because VEGF is a vital supporting factor during neurodevelopment. This review article focuses on the evidence for the use of anti-VEGF treatment in certain pediatric ocular diseases, including ROP, Coats disease, and retinoblastoma. More extensive and prospective studies are warranted to further elucidate the role of anti-VEGF therapy in these diseases and illustrate how we can optimally use these agents in pediatric patients.
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Affiliation(s)
- An-Lun Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
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Follow-up to Age 4 Years of Treatment of Type 1 Retinopathy of Prematurity Intravitreal Bevacizumab Injection versus Laser: Fluorescein Angiographic Findings. Ophthalmology 2018; 125:218-226. [DOI: 10.1016/j.ophtha.2017.08.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 07/19/2017] [Accepted: 08/02/2017] [Indexed: 12/15/2022] Open
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Choi AY, Cho H, Kim YC. Effect of two different doses of intravitreal bevacizumab with temporal retina-sparing laser photocoagulation for retinopathy of prematurity. Int J Ophthalmol 2018; 11:166-169. [PMID: 29376007 DOI: 10.18240/ijo.2018.01.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/18/2017] [Indexed: 11/23/2022] Open
Abstract
This study aims to compare the efficacy and safety between two different doses of intravitreal bevacizumab (IVB) injection with temporal retina-sparing laser (TRSL) photocoagulation for retinopathy of prematurity (ROP). We retrospectively evaluated 22 eyes of ROP infants who underwent IVB combined with partial TRSL for stage 3+ zone I or posterior zone II ROP. Laser photocoagulation was applied on the avascular retina, sparing two-disc-diameter width temporal avascular area anterior to ridge. A half dose (0.625 mg) or minimal dose (0.25 mg) of IVB was conducted. Four eyes in minimal dose group were retreated with IVB and laser photocoagulation on the spared retina. Of those 4 retreated eyes, three developed preretinal hemorrhage around the ridge after the first treatment, resulting in fibrotic macular dragging. A half dose of IVB may be more effective than a minimal dose with partial TRSL for ROP. Preretinal hemorrhage may be a harbinger of poor prognosis.
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Affiliation(s)
- A Young Choi
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu 41931, Korea
| | - Hochan Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Dongsan Medical Center, Daegu 41931, Korea
| | - Yu Cheol Kim
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu 41931, Korea
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Karkhaneh R, Torabi H, Khodabande A, Roohipoor R, Riazi-Esfahani M. Efficacy of Intravitreal Bevacizumab for the Treatment of Zone I Type 1 Retinopathy of Prematurity. J Ophthalmic Vis Res 2018; 13:29-33. [PMID: 29403586 PMCID: PMC5782452 DOI: 10.4103/jovr.jovr_198_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose To describe the efficacy of intravitreal bevacizumab for the treatment of type 1 retinopathy of prematurity (ROP) in zone I. Methods Preterm infants with type 1 ROP in zone I (zone I ROP, any stage with plus disease or zone I ROP, stage 3 without plus disease) were enrolled in this prospective study. Intravitreal bevacizumab (0.625 mg/0.025 ml) was injected under topical anesthesia. Patients were followed weekly for 4 weeks and then biweekly till 90 weeks gestational age. Results Seventy eyes of 35 patients with type 1 ROP in zone I were enrolled. At a gestational age of 90 weeks, ROP regressed with complete or near-complete peripheral retinal vascularization, in 82.9% of eyes after a single injection and in 92.9% of eyes after up to two injections. In five eyes (7.1%), ROP progressed to stage 4B or 5, so surgical management was required. There were no major complications such as endophthalmitis, cataract, or vitreous hemorrhage after injection. Conclusion Intravitreal bevacizumab injection is an effective method for the management of patients with Zone I ROP requiring treatment; however, some cases may progress to more advanced stages and require surgical management. Close monitoring for recurrence or progression is necessary. Eyes with persistent zone I ROP may progress to advanced stages when treated with intravitreal bevacizumab injection and re-treatment may be needed.
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Affiliation(s)
- Reza Karkhaneh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Torabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Alireza Khodabande
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramak Roohipoor
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
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Tran KD, Cernichiaro-Espinosa LA, Berrocal AM. Management of Retinopathy of Prematurity--Use of Anti-VEGF Therapy. Asia Pac J Ophthalmol (Phila) 2018; 7:56-62. [PMID: 29376233 DOI: 10.22608/apo.2017436] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. Although laser photocoagulation re-mains the gold standard for treating threshold and prethreshold disease (type 1 ROP), the off-label use of anti‒vascular endothelial growth factor (anti-VEGF) therapy to treat ROP is increasing. Benefits include acute regression of ROP, growth of retinal vasculature beyond the demarcation line, lesser degree of myopia and peripheral visual field loss, and avoidance of sedation and intubation required for laser. However, controversies regarding anti-VEGF in this vulnerable population persist including choice of anti-VEGF agent, dosing, systemic absorption, safety, and late recurrence. This review updates recent evidence regarding the use of anti-VEGF therapy in the management of ROP.
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Affiliation(s)
- Kimberly D Tran
- Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Audina M Berrocal
- Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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20
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Şahin A, Gürsel-Özkurt Z, Şahin M, Türkcü FM, Yıldırım A, Yüksel H. Ultra-low dose of intravitreal bevacizumab in retinopathy of prematurity. Ir J Med Sci 2017; 187:417-421. [PMID: 28988372 DOI: 10.1007/s11845-017-1684-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/03/2017] [Indexed: 12/20/2022]
Abstract
AIM We aimed to investigate the effectivity of the 0.0625 mg dose of bevacizumab in patients with retinopathy of prematurity (ROP) and compare the results with 0.625 mg dose of intravitreal bevacizumab (IVB) injection. METHODS The medical records of the patients with type 1 ROP who received IVB monotherapy were retrospectively reviewed. Demographic and clinical characteristics of the patients were recorded. The patients were classified into two groups with respect to received dose of bevacizumab as follows: group F (n = 46) (full dose of bevacizumab-0.625 mg/0.025 ml) and group L (n = 45) (low dose (one tenth) of bevacizumab-0.0625 mg/0.025 ml). RESULTS Both treatment dose regimens have similar outcomes. Moreover, the mean retinal vascularization time seemed to be significantly higher in group F compared to group L, 168 ± 65 and 97 ± 29 days, respectively (p < 0.001). Disappearance of plus sign is observed earlier in group F (2.45 ± 1.7 vs 3.66 ± 2.46 days, respectively, p = 0.03). CONCLUSIONS The low dose (0.0625 mg) of IVB treatment was effective as full (0.625 mg) dose in ROP treatment. Moreover, our results showed that low-dose treatment might provide faster retinal vascularization than the regular used dose. On the other hand, disappearance of the plus sign takes longer time in patients treated with low dose compared to eyes treated with full dose of IVB that should be taken into account.
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Affiliation(s)
- A Şahin
- Department of Ophthalmology, Batman Private Hospital, Batman, Turkey.
| | - Z Gürsel-Özkurt
- School of Medicine, Department of Ophthalmology, Dicle University, Diyarbakır, Turkey
| | - M Şahin
- School of Medicine, Department of Ophthalmology, Dicle University, Diyarbakır, Turkey
| | - F M Türkcü
- Department of Ophthalmology, Batman Zilan Hospital, Batman, Turkey
| | - A Yıldırım
- Department of Ophthalmology, Yeni Hayat Hospital, Osmaniye, Turkey
| | - H Yüksel
- Frelance Physician, Diyarbakır, Turkey
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21
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Hillier RJ, Connor AJ, Shafiq AE. Ultra-low-dose intravitreal bevacizumab for the treatment of retinopathy of prematurity: a case series. Br J Ophthalmol 2017; 102:260-264. [DOI: 10.1136/bjophthalmol-2017-310408] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 04/26/2017] [Accepted: 05/06/2017] [Indexed: 01/24/2023]
Abstract
BackgroundIntravitreal bevacizumab (IVB) has emerged as an effective treatment modality for the management of retinopathy of prematurity (ROP) where the disease is severe and posterior. Despite evidence of systemic vascular endothelial growth factor suppression and concerns about how this might affect the developing neonate, the optimal dose is unknown to date. We report our experience of using ultra-low-dose (0.16 mg) IVB, one-quarter of the ‘standard’ dose that has widely been reported in the treatment of ROP.MethodsA retrospective observational case series of consecutive infants who underwent ultra-low-dose IVB injection for the management of ROP at a regional neonatal intensive care unit in the North East of England, between November 2013 and August 2016.Results29 eyes of 15 infants underwent IVB injection. We defined ‘treatment success’ as complete regression of retinopathy and vascularisation into (or laser ablation of) zone 3. Primary success (in response to IVB 0.16 mg alone) was observed in 23/29 eyes (79.3%). Secondary success (where additional treatment was required) was observed in 27/29 eyes (93.1%). One infant died of respiratory disease during follow-up. Retreatment occurred in 6/29 eyes (20.6%). Retreatments occurred at a mean of 9.8 weeks after initial IVB (range 6–15) and at a mean of 44 weeks postmenstrual age (range 40–50).Conclusion0.16 mg IVB is effective in the treatment of severe and posterior ROP, with no adverse ocular outcomes occurring in our series.
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RETINAL VASCULAR DEVELOPMENT WITH 0.312 MG INTRAVITREAL BEVACIZUMAB TO TREAT SEVERE POSTERIOR RETINOPATHY OF PREMATURITY: A Longitudinal Fluorescein Angiographic Study. Retina 2017; 37:97-111. [PMID: 27454223 DOI: 10.1097/iae.0000000000001126] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the outcome of intravitreal 0.312 mg bevacizumab (IVB) monotherapy in acute retinopathy of prematurity (ROP) and to describe the vascular development over time. METHODS Seventeen prematurely born infants were treated with IVB (0.312 mg in 0.025 mL per eye) because of acute ROP in posterior Zone II or Zone I, including aggressive posterior ROP. Infants were examined by fluorescein angiography (FA) using RetCam II or III (Clarity Medical Systems Inc) before IVB (n = 21 eyes), within 6 weeks (n = 23 eyes), 8 to 13 weeks (n = 22 eyes), and up to 45 months (n = 10 eyes). RESULTS Acute ROP regressed in 19 out of 27 analyzed eyes (70%), including 100% and 80% of posterior Zone II and Zone I eyes, respectively, but only 25% of aggressive posterior ROP eyes. Early recurrences (11%, all aggressive posterior ROP) and late reactivations (18%) were observed within 1 week and at 9 to 12 weeks, respectively. All eyes showed leakage at the junction of the vascularized zone and capillary malformation on FA before treatment. Vessel branching abnormalities and circumferential vessel formation were typical FA features after treatment. Vascular outgrowth after one IVB became complete in 87.5% of eyes for which FA was available up to at least 9 weeks after IVB. CONCLUSION A single dose of 0.312 mg bevacizumab was efficient to induce regression of ROP in posterior Zone II and most of Zone I cases, but not in aggressive posterior ROP. FA describes vascular abnormalities, the importance of which warrants further investigation.
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Huang Q, Zhang Q, Fei P, Xu Y, Lyu J, Ji X, Peng J, Li YA, Zhao P. Ranibizumab Injection as Primary Treatment in Patients with Retinopathy of Prematurity: Anatomic Outcomes and Influencing Factors. Ophthalmology 2017; 124:1156-1164. [PMID: 28412066 DOI: 10.1016/j.ophtha.2017.03.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/05/2017] [Accepted: 03/09/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To investigate the anatomic outcomes and influencing factors of ranibizumab in the treatment of retinopathy of prematurity (ROP). DESIGN Retrospective case series. PARTICIPANTS A total of 283 eyes of 145 patients with type 1 ROP treated with intravitreal injection of ranibizumab (IVR) as primary treatment. METHODS Retrospective review of infants who were diagnosed with type 1 ROP and accepted IVR (0.25 mg/0.025 ml) as primary treatment from January 2012 to August 2015. The anatomic outcomes and the influencing factors were analyzed. MAIN OUTCOME MEASURES Anatomic outcomes of ROP eyes after IVR and the influencing factors. RESULTS A total of 283 eyes of 145 patients were included in this study. There were a total of 266 eyes (94.0%) in the positive response group and 17 eyes (6.0%) in the negative/no response group after IVR. Within the positive response group, 139 eyes (48.6%) were in the regression without reactivation subgroup, and 127 eyes (44.9%) were in the regression with reactivation subgroup. A total of 152 eyes received additional laser or surgical treatment. At the last visit, 278 eyes (98.2%) had attached retinas, and 5 eyes (1.8%) had retinal detachment. A classification tree model showed that for patients with gestational age (GA) ≤29.5 weeks, the possibility of experiencing reactivation after IVR is higher than that of those with GA >29.5 weeks (61.6% vs. 29.6%). Moreover, for patients with GA ≤29.5 weeks, those diagnosed with zone II stage 2+ ROP have a lower possibility of experiencing reactivation than other patients (37.9% vs. 80%). CONCLUSIONS Intravitreal injection of ranibizumab seemed to be effective in treating patients with ROP. After treatment, there were primarily 3 different outcomes. Our predictive tree model is helpful for ophthalmologists to evaluate the risk of reactivation.
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Affiliation(s)
- Qiujing Huang
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Zhang
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Fei
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Xu
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiao Lyu
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xunda Ji
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Peng
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-An Li
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peiquan Zhao
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Higher prolactin and vasoinhibin serum levels associated with incidence and progression of retinopathy of prematurity. Pediatr Res 2017; 81:473-479. [PMID: 27842054 DOI: 10.1038/pr.2016.241] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/19/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a potentially blinding, retinal neovascular disease. Systemic prolactin accesses the retina to regulate blood vessels. Prolactin is proangiogenic and can be cleaved to antiangiogenic vasoinhibins. We investigated whether circulating prolactin and vasoinhibins associate with incidence and progression of ROP. METHODS A prospective, longitudinal, case-control study covering postnatal weeks 1 to 9 measured serum prolactin, vasoinhibins, and vascular endothelial growth factor (VEGF) weekly in 90 premature infants diagnosed as ROP or control. RESULTS Prolactin levels were higher in ROP than in control patients before (106.2 ± 11.3 (SEM) vs. 64.7 ± 4.9 ng/ml, postnatal week 1) and during (120.6 ± 10 vs. 84.7 ± 7.5ng/ml, postnatal week 5) ROP diagnosis. Prolactin, but not gestational age, birth weight, Apgar score, sepsis, or ventilation time, correlated with ROP. The relative risk (RR) of developing ROP increased if Prolactin (PRL) levels were higher than thresholds of 80 ng/ml (RR = 1.55, 95% CI: 1.06-2.28), 100 ng/ml (RR = 1.63, 95% CI: 1.14-2.34), or 120 ng/ml (RR = 1.95, 95% CI: 1.41-2.68). Vasoinhibin levels were 39.7% higher (95% CI: 4.5-77.5) in the circulation of ROP than in control patients at postnatal week 1 and similar thereafter, whereas VEGF serum levels were always similar. CONCLUSION High serum prolactin and vasoinhibin levels predict and may impact ROP progression.
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Chung GC, Moon SH. Efficacy of Primary Intravitreal Ranibizumab Injection for Treatment of Type 1 Retinopathy of Prematurity. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.9.1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Gyu Chul Chung
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung-Hyuk Moon
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Khodabande A, Niyousha MR, Roohipoor R. A lower dose of intravitreal bevacizumab effectively treats retinopathy of prematurity. J AAPOS 2016; 20:490-492. [PMID: 27794470 DOI: 10.1016/j.jaapos.2016.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/11/2016] [Accepted: 09/16/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine whether a low dose (0.25 mg/0.01 mL) of intravitreal bevacizumab is effective in the treatment of type 1 retinopathy of prematurity (ROP). METHODS This prospective, noncomparative, interventional case series included all consecutive infants who received 0.25 mg/0.01 mL of intravitreal bevacizumab for type 1 ROP. Infants were followed for ROP persistence/recurrence until 90 weeks' postmenstrual age. RESULTS A total of 49 eyes of 25 infants (24 bilateral and 1 unilateral) underwent intravitreal injection of a reduced dose (0.25 mg/0.01 mL) of intravitreal bevacizumab. ROP regressed in all eyes. Follow-up continued until 90 weeks' postmenstrual age and showed no recurrences of plus disease or neovascularization. CONCLUSIONS All eyes treated with 0.25mg/0.01ml intravitreal bevacizumab showed complete regression, with no recurrence of plus disease or neovascularization. No safety issues were attributable to bevacizumab during the study period.
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Affiliation(s)
- Alireza Khodabande
- Fabrabi Eye Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Reza Niyousha
- Fabrabi Eye Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Ramak Roohipoor
- Fabrabi Eye Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Karkhaneh R, Khodabande A, Riazi-Eafahani M, Roohipoor R, Ghassemi F, Imani M, Dastjani Farahani A, Ebrahimi Adib N, Torabi H. Efficacy of intravitreal bevacizumab for zone-II retinopathy of prematurity. Acta Ophthalmol 2016; 94:e417-20. [PMID: 27009449 DOI: 10.1111/aos.13008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/09/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the effect of intravitreal bevacizumab for Type 1 retinopathy of prematurity (ROP) in zone II ROP. METHODS We conducted a randomized clinical trial. Preterm infants with a gestational age less than 34 weeks or birthweight less than 2000 g were examined at 4 weeks chronological age or 31 weeks postmenstrual age (whichever was later). Preterm infants with Zone-II/Stage 2 or 3 and plus disease were included. Eligible infants were randomized to receive either conventional indirect laser therapy or intravitreal bevacizumab injections (0.625 mg/0.025 ml). The primary outcome was defined as treatment failure: ROP persistence or recurrence by 90 weeks postmenstrual age. RESULTS Our study population comprised 79 infants (158 eyes) with Zone-II ROP. Randomly, 43 infants (86 eyes) were assigned to receive intravitreal bevacizumab and 36 infants (72 eyes) to receive conventional indirect laser therapy. All the infants were followed up at least until 90 weeks postmenstrual age. Stage-3 ROP recurred in nine eyes (10.5%) in the bevacizumab group and one eye (1.4%) in the laser group (p value = 0.018). In recurrent cases after the second treatment, ROP in eight of the nine eyes (88.8%) in the bevacizumab group and the eye in the laser group regressed. CONCLUSION Recurrence of neovascularization with bevacizumab monotherapy seems to be higher than that with conventional laser therapy among infants with Type 1 ROP in zone II ROP but reinjection of bevacizumab causes regression in most recurrent cases.
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Affiliation(s)
- Reza Karkhaneh
- Eye Research Center; Farabi Eye Hospital; Tehran University of Medical Science (TUMS); Tehran Iran
| | - Alireza Khodabande
- Eye Research Center; Farabi Eye Hospital; Tehran University of Medical Science (TUMS); Tehran Iran
| | - Mohammad Riazi-Eafahani
- Eye Research Center; Farabi Eye Hospital; Tehran University of Medical Science (TUMS); Tehran Iran
| | - Ramak Roohipoor
- Eye Research Center; Farabi Eye Hospital; Tehran University of Medical Science (TUMS); Tehran Iran
| | - Fariba Ghassemi
- Eye Research Center; Farabi Eye Hospital; Tehran University of Medical Science (TUMS); Tehran Iran
| | - Marjan Imani
- Eye Research Center; Farabi Eye Hospital; Tehran University of Medical Science (TUMS); Tehran Iran
| | - Afsar Dastjani Farahani
- Eye Research Center; Farabi Eye Hospital; Tehran University of Medical Science (TUMS); Tehran Iran
| | - Nazanin Ebrahimi Adib
- Eye Research Center; Farabi Eye Hospital; Tehran University of Medical Science (TUMS); Tehran Iran
| | - Hamidreza Torabi
- Eye Research Center; Farabi Eye Hospital; Tehran University of Medical Science (TUMS); Tehran Iran
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Toy BC, Schachar IH, Tan GSW, Moshfeghi DM. Chronic Vascular Arrest as a Predictor of Bevacizumab Treatment Failure in Retinopathy of Prematurity. Ophthalmology 2016; 123:2166-75. [PMID: 27506484 DOI: 10.1016/j.ophtha.2016.06.055] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 06/09/2016] [Accepted: 06/23/2016] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To describe a pattern of retinopathy of prematurity (ROP) disease regression and chronic vascular arrest after intravitreal bevacizumab treatment that is not observed after peripheral laser ablation. DESIGN Single-institution retrospective cohort study. PARTICIPANTS Consecutive sample of 58 eyes in 30 patients treated for type 1 ROP. METHODS Initial treatment with either a single intravitreal injection of bevacizumab in off-label use (n = 33 eyes) or peripheral laser ablation (n = 25 eyes) as part of standard clinical care. There was bias in recommending off-label bevacizumab for smaller infants with type 1 ROP. MAIN OUTCOME AND MEASURES Reactivation or persistence of ROP, as determined by clinical examination, fundus photography, and fluorescein angiography. RESULTS All eyes treated initially with bevacizumab demonstrated irregular progression of the leading vascular edge in a stereotyped pattern, suggestive of scalloped regression. Recurrence, based on angiographic demonstration of leakage, or chronic vascular arrest, confirmed based on angiographic demonstration of peripheral ischemia, was noted in 30 eyes (91%) in the bevacizumab group, at a median interval of 14.9 weeks after injection (corrected gestational age, 49.3 weeks). Univariate logistic regression indicated that the need for rescue treatment was associated with decreased birth weight (odds ratio [OR], -0.007; P = 0.04) and age of initial treatment (OR, -0.35; P = 0.05), but not gender, race, or gestational age. Multivariate logistic regression indicated that only decreased birth weight (OR, -0.018; P = 0.04) was associated with need for rescue treatment. CONCLUSIONS Treating ROP with intravitreal bevacizumab results in a characteristic scalloped regression pattern that is highly associated with treatment using biologic anti-vascular endothelial growth factor agents. The presence of this pattern in conjunction with chronic vascular arrest and peripheral retinal ischemia persisting beyond standard screening timelines has significant implications for the management of ROP. Fluorescein angiography is important in assessing vascular maturation in these infants.
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Affiliation(s)
- Brian C Toy
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Ira H Schachar
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Gavin S W Tan
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California; Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Darius M Moshfeghi
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.
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29
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Gunay M, Sukgen EA, Celik G, Kocluk Y. Comparison of Bevacizumab, Ranibizumab, and Laser Photocoagulation in the Treatment of Retinopathy of Prematurity in Turkey. Curr Eye Res 2016; 42:462-469. [PMID: 27420302 DOI: 10.1080/02713683.2016.1196709] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the efficacies and treatment outcomes following intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR), and laser photocoagulation (LPC) in retinopathy of prematurity (ROP). METHODS This was a retrospective interventional case series study including the data of 134 infants (264 eyes) who were treated with IVB, IVR, or LPC for ROP. The data were collected from two major ROP treatment centers in Turkey without any randomization or masking. Regression of ROP, recurrence profile, complications after each treatment modality, and indications for retreatment were evaluated. The main outcome measures included the total inactivation of ROP with anatomic and refractive outcomes at 1.5 years of adjusted age. RESULTS There were 55 infants (41.1%) in the IVB group, 22 infants (16.4%) in the IVR group, and 57 infants (42.5%) in the LPC group. All but 3 infants (5.5%) in the IVB group and 11 infants (50%) in the IVR group showed recurrence to stage 1 and 2 ROP following IVB and IVR (p < 0.001). Retreatment was performed in three infants in both IVB and IVR groups (p = 0.098). At 1.5 years of adjusted age, all infants showed favorable anatomic outcome except one infant in the LPC group. No significant difference of the mean spherical equivalent (SE) was observed between the groups (p = 0.131). In Zone I ROP, laser treated infants had significantly higher rates of myopia and high myopia than IVB and IVR treated infants (p = 0.040 and p = 0.019, respectively). CONCLUSIONS Both IVB and IVR treated infants had significantly better refractive outcomes in Zone I ROP as compared to LPC treated infants at 1.5 years of adjusted age. The higher rate of disease recurrence was associated with IVR. Gestational age (GA) and the zone of ROP were also predictive factors for recurrence of ROP in the study.
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Affiliation(s)
- Murat Gunay
- a Department of Ophthalmology , Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital , Istanbul , Turkey
| | - Emine Alyamac Sukgen
- b Department of Ophthalmology , Adana Numune Training and Research Hospital , Adana , Turkey
| | - Gokhan Celik
- a Department of Ophthalmology , Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital , Istanbul , Turkey
| | - Yusuf Kocluk
- b Department of Ophthalmology , Adana Numune Training and Research Hospital , Adana , Turkey
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Cam D, Berk AT, Micili SC, Kume T, Ergur BU, Yilmaz O. Histological and Immunohistochemical Retinal Changes Following the Intravitreal Injection of Aflibercept, Bevacizumab and Ranibizumab in Newborn Rabbits. Curr Eye Res 2016; 42:315-322. [DOI: 10.3109/02713683.2016.1164190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Duygu Cam
- Department of Ophthalmology, State Hospital, Tunceli, Turkey
| | - Ayse Tulin Berk
- Department of Ophthalmology, Dokuz Eylul University, School of Medicine, Izmır, Turkey
| | - Serap Cilaker Micili
- Department of Histology and Embryology, Dokuz Eylul University, School of Medicine, Izmır, Turkey
| | - Tuncay Kume
- Department of Biochemistry, Dokuz Eylul University, School of Medicine, Izmır, Turkey
| | - Bekir Ugur Ergur
- Department of Histology and Embryology, Dokuz Eylul University, School of Medicine, Izmır, Turkey
| | - Osman Yilmaz
- Multidisciplinary Laboratory, Dokuz Eylul University, School of Medicine, Izmır, Turkey
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Henry CR, Sisk RA, Tzu JH, Albini TA, Davis JL, Murray TG, Berrocal AM. Long-term follow-up of intravitreal bevacizumab for the treatment of pediatric retinal and choroidal diseases. J AAPOS 2015; 19:541-8. [PMID: 26691034 DOI: 10.1016/j.jaapos.2015.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/16/2015] [Accepted: 09/27/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the long-term outcomes of intravitreal bevacizumab (IVB) for the treatment of pediatric retinal and choroidal diseases. METHODS This was a multicenter, retrospective, consecutive case series of patients <18 years of age treated with IVB from 2005 to 2013. Primary outcome measures included visual acuity and central macular thickness at 12 months' follow-up. RESULTS A total of 95 eyes of 90 patients (average age, 8.7 years [range, 0.33-17 years]) were included, in which 352 injections (average, 3.7/eye) were administered for choroidal neovascular membrane (CNVM, n = 35), Coats disease (n = 35), familial exudative vitreoretinopathy (FEVR, n = 13), cystoid macular edema (CME, n = 6), and other (n = 6). Mean follow-up was 679 ± 581 days. IVB was used as monotherapy in 27 eyes and as part of combination therapy in 68. Mean Snellen equivalent visual acuity improved from 20/224 at baseline to 20/120 at 6 months (P = 0.034) and 20/108 at 12 months (P = 0.005). Mean central macular thickness improved from 426 μm to 349 μm at 6 months (P = 0.025) and 340 μm at 12 months (P = 0.002). Statistically significant visual acuity gains at 12 months were achieved in patients with CNVM (P = 0.009) but not in eyes with CME (P = 0.06), Coats disease (P = 0.15), or FEVR (P = 0.93). Adverse effects included ocular hypertension in 8 eyes and worsening tractional retinal detachment in 3 eyes. CONCLUSIONS Patients receiving IVB as part of the treatment for pediatric retinal and choroidal diseases experienced significant visual acuity gains and reductions in central macular thickness. IVB was generally well tolerated, although safety concerns persist.
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Affiliation(s)
- Christopher R Henry
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
| | - Robert A Sisk
- Department of Ophthalmology, Cincinnati Eye Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan H Tzu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Janet L Davis
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Serial evaluation of retinal vascular changes in infants treated with intravitreal bevacizumab for aggressive posterior retinopathy of prematurity in zone I. Eye (Lond) 2015; 30:392-9. [PMID: 26584796 DOI: 10.1038/eye.2015.240] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/06/2015] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To evaluate the serial changes in retinal vasculature in infants treated with intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity (APROP) in zone I. METHODS Retrospective analysis of serial changes in retinal vasculature after IVB in the seven eyes of four babies with APROP in zone I. RESULTS The initial regression, following IVB, was dramatic with reduction in vessel caliber and marked thinning and invisibility of the bridging shunts. Resurgent vascular development was very slow radially though there was continued abnormal vascular growth circumferentially. Common findings in all eyes were tangled vasculature and fine saw-toothed shunts. The variable findings were (1) new closely packed multilayered bridging shunts, long arching mature looking vessels, and finally a ridge at the periphery (n=3 eyes) at 52 weeks of postmenstrual age (PMA); (2) status quo at the stage of saw-toothed shunt and ridge in both eyes for a long time (n=2 eyes); and (3) multiple retinal hemorrhages within the vascularized retina and thick preretinal hemorrhage overlying the saw-toothed shunts and ridge that persisted for another 3 weeks and regressed 2 weeks after laser (n=1). The eyes that received bevacizumab alone (3) did not show any abnormal vascularization at 56 weeks of PMA or beyond. CONCLUSIONS The retinal vascularization following IVB was different than normal in terms of its time, speed, and morphology; few of these changes are first to be reported in the literature (Medline search) and warrants further studies.
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Pertl L, Steinwender G, Mayer C, Hausberger S, Pöschl EM, Wackernagel W, Wedrich A, El-Shabrawi Y, Haas A. A Systematic Review and Meta-Analysis on the Safety of Vascular Endothelial Growth Factor (VEGF) Inhibitors for the Treatment of Retinopathy of Prematurity. PLoS One 2015; 10:e0129383. [PMID: 26083024 PMCID: PMC4470662 DOI: 10.1371/journal.pone.0129383] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/07/2015] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Laser photocoagulation is the current gold standard treatment for proliferative retinopathy of prematurity (ROP). However, it permanently reduces the visual field and might induce myopia. Vascular endothelial growth factor (VEGF) inhibitors for the treatment of ROP may enable continuing vascularization of the retina, potentially allowing the preservation of the visual field. However, for their use in infants concern remains. This meta-analysis explores the safety of VEGF inhibitors. METHODS The Ovid Interface was used to perform a systematic review of the literature in the databases PubMed, EMBASE and the Cochrane Library. RESULTS This meta-analysis included 24 original reports (including 1.457 eyes) on VEGF inhibitor treatment for ROP. The trials were solely observational except for one randomized and two case-control studies. We estimated a 6-month risk of retreatment per eye of 2.8%, and a 6-month risk of ocular complication without the need of retreatment of 1.6% per eye. Systemic complications were only reported as isolated incidents. DISCUSSION VEGF inhibitors seem to be associated with low recurrence rates and ocular complication rates. They may have the benefit of potentially allowing the preservation of visual field and lower rates of myopia. Due to the lack of data, the risk of systemic side effects cannot be assessed.
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Affiliation(s)
- Laura Pertl
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Gernot Steinwender
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Christoph Mayer
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Silke Hausberger
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Eva-Maria Pöschl
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Werner Wackernagel
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Andreas Wedrich
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Yosuf El-Shabrawi
- Department of Ophthalmology, Klagenfurt Hospital, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Anton Haas
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
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Klufas MA, Chan RVP. Intravitreal anti-VEGF therapy as a treatment for retinopathy of prematurity: what we know after 7 years. J Pediatr Ophthalmol Strabismus 2015; 52:77-84. [PMID: 25798707 DOI: 10.3928/01913913-20150216-01] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 12/10/2014] [Indexed: 12/21/2022]
Abstract
The authors review published clinical case reports, case series, and clinical trials evaluating the use of anti-vascular endothelial growth factor (VEGF) medications for the primary or adjunctive treatment of retinopathy of prematurity (ROP). A literature search of peer reviewed reports on PubMed was performed. More than 50 pertinent peer-reviewed publications between 2006 and 2014 were selected to be included in this review and are summarized in this report. There is a growing body of literature on the use of anti-VEGF therapy as a treatment for ROP, predominately in the form of case reports and small case series. Adverse effects from anti-VEGF treatment for ROP have been reported, but with limited follow-up time. The use of anti-VEGF as a treatment for ROP remains off-label.
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Outcomes after Intravitreal Bevacizumab versus Laser Photocoagulation for Retinopathy of Prematurity: A 5-Year Retrospective Analysis. Ophthalmology 2015; 122:1008-15. [PMID: 25687024 DOI: 10.1016/j.ophtha.2014.12.017] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 11/26/2014] [Accepted: 12/15/2014] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To determine the relative effectiveness, major complications, and refractive errors associated with intravitreal bevacizumab (IVB) versus panretinal photocoagulation (PRP) to treat type 1 retinopathy of prematurity (ROP). DESIGN Retrospective case series. PARTICIPANTS Consecutive infants with type 1 ROP who received either IVB or PRP and had at least 6 months of follow-up. METHODS The data from infants treated with either IVB or PRP for type 1 ROP between 2008 and 2012 were recorded from 2 medical centers in Atlanta, Georgia. MAIN OUTCOME MEASURES Recurrence rate, complication rate, and refractive error. RESULTS A total of 54 eyes (28 patients) with type 1 ROP were evaluated: 22 eyes (11 patients) received IVB, and 32 eyes (17 patients) received PRP. Among the 22 eyes treated with IVB, 16 eyes had zone I ROP and 6 eyes had posterior zone II ROP. The number of zone I and II ROP eyes treated with PRP were 5 and 27, respectively. Mean gestational age, birth weight, postmenstrual age at initial treatment, and follow-up period for the infants receiving IVB were 24.2 weeks, 668.1 g, 35.1 weeks, and 21.7 weeks, respectively, and for the infants receiving PRP, these were 24.8 weeks, 701.4 g, 36.1 weeks, and 34.5 weeks, respectively. Retinopathy of prematurity recurred in 3 (14%) of 22 IVB-treated eyes and in 1 (3%) of 32 PRP-treated eyes. Neither retinal detachment nor macular ectopia developed in any of the IVB-treated eyes. In PRP-treated eyes, retinal detachment developed in only 1 eye and macular ectopia developed in 5 eyes. Mean spherical equivalent and postgestational age at the last refraction for IVB-treated eyes were -2.4 diopters (D) and 22.4 months, respectively, and for PRP-treated eyes, these were -5.3 D and 37.1 months, respectively. Mean spherical equivalent for zone I ROP eyes treated with IVB and PRP were -3.7 D and -10.1 D, respectively, and for zone II ROP eyes, these were 0.6 D and -4.7 D, respectively. CONCLUSIONS Both IVB and PRP are effective treatment options for type 1 ROP with low complication rates. IVB was associated with less myopia than PRP, although longer follow-up was available for PRP.
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Lorenz B, Stieger K. Retinopathy of prematurity: recent developments in diagnosis and treatment. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1007128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Kim SE, Rim THT, Lee CS. Effect of Primary Intravitreal Bevacizumab Injection on Stage 3 Retinopathy of Prematurity with Plus Signs. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.1.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sung Eun Kim
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Tyler Hyung Taek Rim
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Stahl A, Hellstrom A, Smith LEH. Insulin-like growth factor-1 and anti-vascular endothelial growth factor in retinopathy of prematurity: has the time come? Neonatology 2014; 106:254-60. [PMID: 25300950 PMCID: PMC4197141 DOI: 10.1159/000365132] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Treatment of retinopathy of prematurity (ROP) is currently evolving. Novel therapeutic options are emerging that have the potential to complement existing therapies and improve treatment outcomes. However, any new therapeutic option must be thoroughly evaluated before existing (and successful) treatment paradigms can be amended. This is particularly so when switching from locally effective therapies like photoablative laser therapy to systemic pharmacological treatments, which may have hitherto unknown widespread side effects. This review compiles the current knowledge of where and when the two most advanced pharmacological treatment options for ROP, insulin-like growth factor-1 supplementation and anti-vascular endothelial growth factor treatment, may have their place in future therapy regimens for ROP. The requirement for clinical studies is emphasized: these are needed to address safety considerations before any of these interventions can achieve the status of standard clinical care in the very vulnerable population of ROP infants.
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Affiliation(s)
- Andreas Stahl
- Eye Center, University of Freiburg, Freiburg, Germany
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Araz-Ersan B, Kir N, Tuncer S, Aydinoglu-Candan O, Yildiz-Inec D, Akdogan B, Ekici B, Demirel A, Ozmen M. Preliminary Anatomical and Neurodevelopmental Outcomes of Intravitreal Bevacizumab As Adjunctive Treatment for Retinopathy of Prematurity. Curr Eye Res 2014; 40:585-91. [DOI: 10.3109/02713683.2014.941070] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Premature infants born at 30 weeks' gestational age or younger, or 1500 g or smaller, are screened for retinopathy of prematurity (ROP). Guidelines for supplemental oxygen in neonatal intensive care units have decreased but not eliminated the incidence of severe ROP. The underlying cause for ROP is prematurity and low birth weight, and with the survival of smaller and younger babies, ROP continues to be a significant problem facing premature infants. Threshold ROP is treated with retinal photocoagulation, but newer treatments such as intraocular injections of bevacizumab (Avastin) are being used alone or in conjunction with laser.
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Affiliation(s)
- Catherine O Jordan
- Department of Ophthalmology, Nationwide Children's Hospital, 555 South 18th Street, Suite 4C, Columbus, OH 43025, USA.
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Wang H, Yang Z, Jiang Y, Flannery J, Hammond S, Kafri T, Vemuri SK, Jones B, Hartnett ME. Quantitative analyses of retinal vascular area and density after different methods to reduce VEGF in a rat model of retinopathy of prematurity. Invest Ophthalmol Vis Sci 2014; 55:737-44. [PMID: 24425858 DOI: 10.1167/iovs.13-13429] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Targeted inhibition of Müller cell (MC)-produced VEGF or broad inhibition of VEGF with an intravitreal anti-VEGF antibody reduces intravitreal neovascularization in a rat model of retinopathy of prematurity (ROP). In this study, we compared the effects of these two approaches on retinal vascular development and capillary density in the inner and deep plexi in the rat ROP model. METHODS In the rat model of ROP, pups received 1 μL of (1) subretinal lentivector-driven short hairpin RNA (shRNA) to knockdown MC-VEGFA (VEGFA.shRNA) or control luciferase shRNA, or (2) intravitreal anti-VEGF antibody (anti-VEGF) or control isotype goat immunoglobulin G (IgG). Analyses of lectin-stained flat mounts at postnatal day 18 (p18) included: vascular/total retinal areas (retinal vascular coverage) and pixels of fluorescence/total retinal area (capillary density) of the inner and deep plexi determined with the Syncroscan microscope, and angles between cleavage planes of mitotic vascular figures labeled with anti-phosphohistone H3 and vessel length. RESULTS Retinal vascular coverage and density increased in both plexi between p8 and p18 in room air (RA) pups. Compared with RA, p18 ROP pups had reduced vascular coverage and density of both plexi. Compared with respective controls, VEGFA.shRNA treatment significantly increased vascular density in the deep plexus, whereas anti-VEGF reduced vascular density in the inner and deep plexi. Vascular endothelial growth factor-A.shRNA caused more cleavage angles predicting vessel elongation and fewer mitotic figures, whereas anti-VEGF treatment led to patterns of pathologic angiogenesis. CONCLUSIONS Targeted treatment with lentivector-driven VEGFA.shRNA permitted physiologic vascularization of the vascular plexi and restored normal orientation of dividing vascular cells, suggesting that regulation of VEGF signaling by targeted treatment may be beneficial.
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Affiliation(s)
- Haibo Wang
- Department of Ophthalmology, The John Moran Eye Center, University of Utah, Salt Lake City, Utah
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