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Jang JH. Characteristics of retinal vascularization in reactivated retinopathy of prematurity requiring treatment and clinical outcome after reinjection of ranibizumab. Sci Rep 2024; 14:15647. [PMID: 38977744 PMCID: PMC11231209 DOI: 10.1038/s41598-024-66483-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
This study aimed to determine whether the state of retinal vascularization after anti-vascular endothelial growth factor (anti-VEGF) injection can help predict the risk of reactivated retinopathy of prematurity (ROP) requiring treatment and whether repeated ranibizumab injection will be effective in such cases. We retrospectively reviewed 24 infants (43 eyes) who received ranibizumab monotherapy between January 2021 and December 2022. All eyes were classified as having non-retreated ROP or retreated ROP. The state of ROP at the time of treatment, the time required for resolution of plus disease, and the extent of vascularization at 4 and 8 weeks after treatment were analyzed. Extent of temporal retinal vascularization was measured with serial fundus images using disc-fovea distance (DF) unit and disc diameter (DD). Reactivated ROP requiring treatment occurred in six infants (25.0%) and ten eyes (23.3%) after ranibizumab treatment. The mean retreatment interval was 9.0 ± 3.3 weeks (range 4-16). In the retreated ROP group, the time required for the resolution of plus disease after primary injection was longer compared to the control group (13.3 days vs 5.2 days), with a mean ROP regression time of 3.4 weeks. All eyes in the retreated ROP showed retinal vascularization < 0.5 DF from the original site at 4 weeks after injection. In 90% of cases with retreated ROP, the extent of vascularization at 8 weeks after injection was within 1 DF from the original ROP site, and all cases showed reactivation in the posterior Zone II area. The extent of retinal neovascularization in the retreated group was an average of 0.7 DD (vs 1.7 DD) and 1.3 DD (vs 3.3 DD) at 4 and 8 weeks after injection, respectively. After ranibizumab retreatment, only one reactivated case with vitreous traction progressed to focal retinal detachment, while all other cases regressed with peripheral vascular development. The continuation of delayed retinal blood vessel development after ≥ 8 weeks may indicate a high likelihood of reactivated ROP requiring treatment. In the absence of vitreous traction, ranibizumab reinjection is likely to be effective in treating reactivated ROP requiring treatment.
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Affiliation(s)
- Ji Hye Jang
- Department of Ophthalmology, School of Medicine, Keimyung University, Daegu, 42601, Republic of Korea.
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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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Chen J, Hao Q, Zhang J, Du Y, Chen H, Cheng X. The efficacy and ocular safety following aflibercept, conbercept, ranibizumab, bevacizumab, and laser for retinopathy of prematurity: a systematic review and meta-analysis. Ital J Pediatr 2023; 49:136. [PMID: 37814332 PMCID: PMC10561404 DOI: 10.1186/s13052-023-01543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is typically treated with laser photocoagulation and/or intravitreal anti-vascular endothelial growth factor (anti-VEGF). To the best of our knowledge, most systematic reviews have focused on comparing anti-VEGF against laser treatment while comparisons between different anti-VEGF agents are lacking. Thus, we conducted this meta-analysis to compare the efficacy and safety of different anti-VEGF agents or laser after primary ROP therapy. METHODS We conducted a comprehensive search across multiple databases up to November 2022. We included studies that used anti-VEGF or laser for ROP with comparable cohorts. RESULTS Overall, 44 studies were included in this meta-analysis. When comparing anti-VGEF with laser, we found that the anti-VEGF group had a significantly higher retreatment rate (RR = 1.56, 95%CI = [1.06, 2.31], p = 0.03), a longer time from treatment to retreatment (WMD = 5.99 weeks, 95%CI = [4.03, 7.95], p < 0.001), a lower retinal detachment rate (RR = 0.55, 95%CI = [0.30, 0.91], p = 0.02), higher spherical equivalent (WMD = 1.69D, 95%CI = [0.61, 2.77], p = 0.002), lower myopia rate (RR = 0.69, 95%CI = [0.50, 0.97], p = 0.03) and lower anisometropia rate (RR = 0.44, 95%CI = [0.29, 0.67], p = 0.0001). In comparisons between ranibizumab and bevacizumab, the intravitreal ranibizumab (IVR) group was associated with higher recurrence rate (RR = 2.02, 95%CI = [1.49, 2.73], p < 0.0001), higher retreatment rate (RR = 1.70, 95%CI = [1.17, 2.47], p = 0.0006), and lower high myopia rate (RR = 0.31, 95%CI = [0.12, 0.77], p = 0.01). Similarly, when compared to aflibercept and conbercept, the IVR cohort also demonstrated higher recurrence and retreatment rates. While no significant differences were observed in any of the variables included in the statistical analysis in the comparison between bevacizumab and aflibercept. CONCLUSIONS Anti-VEGF was associated with higher retreatment and lesser incidence of myopia as compared to laser. Laser therapy was linked to more complications like retinal detachment and myopia. Ranibizumab exhibited higher recurrence and retreatment rates compared to bevacizumab, aflibercept, and conbercept.
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Affiliation(s)
- Jing Chen
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Qingfei Hao
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Jing Zhang
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Yanna Du
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Haoming Chen
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Xiuyong Cheng
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China.
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Abstract
Retinopathy of prematurity (ROP) is a complex disease involving development of the neural retina, ocular circulations, and other organ systems of the premature infant. The external stresses of the ex utero environment also influence the pathophysiology of ROP through interactions among retinal neural, vascular, and glial cells. There is variability among individual infants and presentations of the disease throughout the world, making ROP challenging to study. The methods used include representative animal models, cell culture, and clinical studies. This article describes the impact of maternal-fetal interactions; stresses that the preterm infant experiences; and biologic pathways of interest, including growth factor effects and cell-cell interactions, on the complex pathophysiology of ROP phenotypes in developed and emerging countries.
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Patel NA, Acaba-Berrocal LA, Hoyek S, Fan KC, Martinez-Castellanos MA, Baumal CR, Harper CA, Berrocal AM. Comparison in Retreatments between Bevacizumab and Ranibizumab Intravitreal Injections for Retinopathy of Prematurity: A Multicenter Study. Ophthalmology 2023; 130:373-378. [PMID: 36396121 DOI: 10.1016/j.ophtha.2022.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare the types and dosages of anti-vascular endothelial growth factors (VEGFs) to ascertain whether specific dosages or types of injection were associated with retreatment in clinical practice in the United States. DESIGN Multicenter, retrospective, consecutive series. PARTICIPANTS Patients with retinopathy of prematurity (ROP) treated with anti-VEGF injections from 2007 to 2021. METHODS Sixteen sites from the United States participated. Data collected included demographics, birth characteristics, examination findings, type and dose of anti-VEGF treatment, retreatment rates, and time to retreatment. Comparisons of retreatment rates between bevacizumab and ranibizumab intravitreal injections were made. MAIN OUTCOME MEASURES Relative rate of retreatment between varying types of anti-VEGF therapy, including bevacizumab and ranibizumab, and the various dosages used for each. RESULTS Data from 873 eyes of 661 patients (61% male and 39% female) were collected. After exclusion of 40 eyes treated with laser before anti-VEGF injection and 266 eyes re-treated with laser at or beyond 8 weeks after the initial anti-VEGF treatment, 567 eyes of 307 patients (63% male and 37% female) remained and were included in the primary analysis. There was no difference between the no retreatment and retreatment groups in terms of birthweight, gestational age, age at first injection, ROP stages, or number of involved clock hours. The retreatment group had a larger percentage of aggressive ROP (34% vs. 18%, P < 0.001) and greater percentage of zone 1 ROP (49 vs. 34%, P = 0.001) than the no retreatment group. Ranibizumab use was associated with a higher rate of retreatment than bevacizumab use (58% vs. 37%, P < 0.001), whereas the rate of retreatment was not associated with a specific dose of ranibizumab (R2 = 0.67, P = 0.32). Meanwhile, lower doses of bevacizumab were associated with higher rates of retreatment compared with the higher doses (R2 = 0.84, P = 0.01). There was a dose-specific trend with higher doses trending toward lower retreatments for bevacizumab. CONCLUSIONS In a multicenter study of ROP patients initially treated with anti-VEGF therapy, ranibizumab and lower-dose bevacizumab use were associated with an increased rate of retreatment when compared with higher-dose bevacizumab. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Luis A Acaba-Berrocal
- Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Kenneth C Fan
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Maria Ana Martinez-Castellanos
- Association to Prevent Blindness, Hospital Luis Sanchez Bulnes, National Autonomous University of Mexico, Mexico City, Mexico
| | - Caroline R Baumal
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - C Armitage Harper
- Department of Ophthalmology, Austin Retina Associates, Austin, Texas
| | - Audina M Berrocal
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
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Lesovoy SV, Boginskaya OA. Applying Lucentis for the treatment of retinopathy of prematurity. RUSSIAN OPHTHALMOLOGICAL JOURNAL 2022. [DOI: 10.21516/2072-0076-2022-15-4-45-48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose: to evaluate the efficacy of Lucentis for the treatment of retinopathy of prematurity (ROP). Material and methods. 51 infants (102 eyes) with the gestational age between 24 and 33 weeks were given intravitreal injections of Lucentis, All patients selected had ROP stages I+, II+, III or III+ in zone 1, stage III+ in zone 2, or aggressive posterior ROP. The procedure was performed under general anesthesia; the dose, technique and the number of Lucentis injections conformed with the recommendations given in Lucentis instruction for use. If indicated, retinal laser photocoagulation was given after intravitreal injections using Supra (Quantel Medical, France) and Lachta-Mylon (Russia, Lasermedservis) laser equipment. Results. Clinical efficacy of intravitreal administration of Ranibizumab in infants with aggressive posterior ROP, zone 1 ROP, Stage III of zone 2 ROP was determined at 86.3 % (with no more than two injections). If ROP remains active after two injections, a change of therapy is recommended. Vascularization was noted to be complete in 51 % of cases. Conclusion. To achieve a maximum treatment effect of ROP with Lucentis, strict observation of indications criteria must take place.
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Tawfik GM, Shahein EA, Dabour SA, Hassanein D, Elshewy AM. Comparison of intravitreal injection of ranibizumab versus bevacizumab for treatment of type 1 and aggressive retinopathy of prematurity in rural Egypt. A randomized clinical trial. BMJ Open Ophthalmol 2022. [DOI: 10.1136/bmjophth-2022-001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
ObjectiveThe objective of this study is to evaluate the efficacy of intravitreal ranibizumab (IVR) monotherapy compared with intravitreal bevacizumab (IVB) monotherapy for treatment of type 1 and aggressive retinopathy of prematurity (ROP) in rural Egypt.Methods36 eyes of 18 infants with bilateral aggressive or type 1 ROP were recruited between September 2020 and September 2022. Mean follow-up duration was 16.53 months. IVB was injected in the right eye and IVR in the left eye, rescue injection of the same initial anti-vascular endothelial growth factor (VEGF) in case of ROP reactivation. Outcome measures included regression achieved either by single injection or multiple injections or additional laser therapy at 55 weeks’ postmenstrual age (PMA), recurrence of ROP, total retinal vascularisation time and complications.ResultsInitial regression of ROP within 1 week occurred in 11/18 eyes (61.1%) in bevacizumab group and 15/18 eyes (83.3%) in ranibizumab group (p=0.137). Primary outcome measure was achieved in 14/18 eyes (77.8%) and 16/18 eyes (88.9%) in bevacizumab and ranibizumab groups, respectively (p=0.658). Late reactivation requiring retreatment with anti-VEGF was encountered in 4/18 eyes (22.2%) and 1/18 eyes (5.6%) in bevacizumab and ranibizumab groups, respectively (p=0.338). Peripheral laser therapy on the avascular retina was done in 3/18 eyes (16.7%) in each group at mean of 55.67 weeks' PMA.ConclusionBevacizumab and ranibizumab proved to be effective regarding regression of acute ROP and continuing peripheral retinal vascularisation. Higher proportion of reactivation with bevacizumab, however, clinically non-significant. Laser therapy can be postponed to reduce its complications.Trial registration numberNCT05033106.
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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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Al Rasheed R, Adhi MI, Alowedi SA, Albdah B, Aldebasi T, Hazzazi MA. Long-term peripheral retinal vascular behavior in retinopathy of prematurity patients treated with ranibizumab intravitreal injection as monotherapy using fluorescein angiography. Int J Retina Vitreous 2022; 8:53. [PMID: 35918740 PMCID: PMC9344754 DOI: 10.1186/s40942-022-00402-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few challenges are faced with the introduction of anti-VEGF agents as a modality of treatment for retinopathy of prematurity. The clinical behavior and time course of regression post injection differ compared to post laser ablation. This study aims to evaluate the long-term peripheral retinal vascularization outcome of Ranibizumab intravitreal injections monotherapy in the treatment of retinopathy of prematurity. METHOD Hospital-based quasi-experimental study. Include ROP patients who received intravitreal ranibizumab (IVR), as primary treatment for type 1 ROP. Patients were examined under general anaesthesia to ensure documentation of all junctions of vascular and avascular zones. Images were taken by RetCam III, Phoenix ICON and fluorescein angiography was performed to describe vascular behaviors. RESULTS The mean gestational age was 24.67 weeks and the mean postmenstrual age at the time of intravitreal ranibizumab treatment was 36.3 weeks. Fluorescein angiography was performed at 155-288 weeks; most eyes showed two disk diameters of avascular peripheral retina. Only eyes with original aggressive ROP who required a second injection (six eyes) showed extensive peripheral avascular retina reaching zone I (13.64%). Neovascularization was evident in five eyes (11.36%), all with an original aggressive ROP and received multiple injections. CONCLUSIONS Ranibizumab treated babies with incomplete retinal vascularization require close and long-term follow-up visits to assess post injection vascular behavior. Peripheral retinal avascular zone of more than two-disc diameters was present in most of the patients evidenced by fluorescein angiography. Babies with initial diagnosis of aggressive ROP are more likely to have persistent peripheral neovascularization.
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Affiliation(s)
- Raghad Al Rasheed
- Department of Ophthalmology, King Abdulaziz Medical City, National Guard Health Affairs, PO Box 22490, Riyadh, 11426, Saudi Arabia
| | - Mohammad Idrees Adhi
- Department of Ophthalmology, King Abdulaziz Medical City, National Guard Health Affairs, PO Box 22490, Riyadh, 11426, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sarah Abdullah Alowedi
- Department of Ophthalmology, King Abdulaziz Medical City, National Guard Health Affairs, PO Box 22490, Riyadh, 11426, Saudi Arabia
| | - Bayan Albdah
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Tariq Aldebasi
- Department of Ophthalmology, King Abdulaziz Medical City, National Guard Health Affairs, PO Box 22490, Riyadh, 11426, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammad A Hazzazi
- Department of Ophthalmology, King Abdulaziz Medical City, National Guard Health Affairs, PO Box 22490, Riyadh, 11426, Saudi Arabia. .,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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Chow SC, Lam PY, Lam WC, Fung NSK. The role of anti-vascular endothelial growth factor in treatment of retinopathy of prematurity-a current review. Eye (Lond) 2022; 36:1532-1545. [PMID: 35017699 PMCID: PMC9307789 DOI: 10.1038/s41433-021-01922-2] [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: 07/08/2021] [Revised: 11/27/2021] [Accepted: 12/22/2021] [Indexed: 11/08/2022] Open
Abstract
The review aims to evaluate the uses of conventional laser therapy and intravitreal injection of various anti-VEGF in terms of efficacy and side effects for the treatment of retinopathy of prematurity. A literature search of the publication, concerning conventional laser treatment and intravitreal injection of anti-VEGF for ROP. A total of 40 articles were reviewed after curation by the authors for relevance. Intravitreal anti-VEGF showed better ocular efficacy in zone I ROP while laser therapy had a lower recurrence rate in zone II. Comparing the two mainstay anti-VEGF agents, bevacizumab showed lower ROP recurrence rate than ranibizumab. Anti-VEGF has a higher chance in developing persistent peripheral avascularisation compared to conventional laser therapy, but a lower chance of developing high myopia. Ranibizumab has a lower systemic absorption than bevacizumab, despite having no difference in the incidence of persistent peripheral avascularisation. In conclusion, it is advised that intravitreal anti-VEGF should be used as the first-line treatment for zone I ROP while laser therapy should be the mainstay for zone II ROP owing to the different pathogenetic mechanisms. In patients with recurrence after initial anti-VEGF injection, that given ranibizumab may opt to repeat the injection while that given bevacizumab should consider supplement laser ablative treatment.
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Affiliation(s)
- Shing Chuen Chow
- The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Pun Yuet Lam
- The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wai Ching Lam
- The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Queen Mary Hospital & Grantham Hospital, Pok Fu Lam, Hong Kong
| | - Nicholas Siu Kay Fung
- The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.
- Queen Mary Hospital & Grantham Hospital, Pok Fu Lam, Hong Kong.
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Xia F, Lyu J, Peng J, Zhao P. Repeated intravitreal ranibizumab for reactivated retinopathy of prematurity after intravitreal ranibizumab monotherapy: vascular development analysis. Graefes Arch Clin Exp Ophthalmol 2022; 260:2837-2846. [PMID: 35438363 DOI: 10.1007/s00417-022-05628-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/21/2022] [Accepted: 03/10/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To evaluate the retinal vascularization of repeated intravitreal ranibizumab (IVR) for reactivated retinopathy of prematurity (ROP) treated with IVR monotherapy. METHODS The retrospective study reviewed ROP infants who accepted IVR injection as the first treatment in our department from January 2017 to December 2018. The ratio of the distance from the center of the optic disc to the border of the vascularized zone (DB) to the distance from the center of the disc to the fovea (DF) was used for the vascular outgrowth analysis. RESULTS Seventy-eight infants were included in the study. A total of 54.3% of the reactivated ROP patients could achieve complete vascularization after repeated IVR injections. Gestational age (GA) > 29 weeks and a temporal DB/DF ratio ≥ 3 in the first IVR were potential predictors for complete retinal vascularization after IVR monotherapy. The temporal DB/DF ratio ≥ 3.6 in the second IVR injection was a potential predictor for complete retinal vascularization after repeated IVR for ROP reactivation. CONCLUSIONS Reactivated ROP after IVR monotherapy can be treated successfully with repeated IVR injections. GA and temporal DB/DF ratio are potential predictors of complete retinal vascularization in ROP infants treated with IVR.
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Affiliation(s)
- Fengjie Xia
- Department of Ophthalmology, Xinhua Hospital, Affiliated To Medicine School of Shanghai Jiaotong University, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Jiao Lyu
- Department of Ophthalmology, Xinhua Hospital, Affiliated To Medicine School of Shanghai Jiaotong University, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Jie Peng
- Department of Ophthalmology, Xinhua Hospital, Affiliated To Medicine School of Shanghai Jiaotong University, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital, Affiliated To Medicine School of Shanghai Jiaotong University, No. 1665, Kongjiang Road, Shanghai, 200092, China.
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12
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Beccasio A, Mignini C, Caricato A, Iaccheri B, Di Cara G, Verrotti A, Cagini C. New trends in intravitreal anti-VEGF therapy for ROP. Eur J Ophthalmol 2022; 32:1340-1351. [PMID: 35040348 DOI: 10.1177/11206721211073405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Retinopathy of Prematurity (ROP) affects premature newborns, and it can cause childhood blindness and visual impairment if untreated. The understanding of the pathogenetic role of Vascular Endothelial Growth Factor (VEGF) has led to development of therapeutic strategies such as intravitreal anti-VEGF drugs. We reported drug efficacy and ROP recurrence rates, extrapolated from the reviewed studies. Association of Pegabtanib and laser photocoagulation confers efficacy in the regression of ROP stage 3 plus in zone I / II in 89.7% of treated eyes, reducing the recurrence rate to 14.6% compared to 50% of laser therapy alone. Irrespective of the dose, Ranibizumab demonstrated average efficacy greater than 75% on regression of active disease with the highest rates of the dose of 0.1 mg (92.5%). The recurrence, on the other hand, is the highest among this new anti-VEGF agents and is around an average of 41.5%, which records the highest values in the case of Aggressive Posterior Rop (APROP). Aflibercept at a dose of 1 mg demonstrated average efficacy of about 81.9% of treated infants, analyzing significantly fewer studies than Ranibizumab. The recurrence rate stands at an average of 28.9%, especially in the later forms of ROP. Using a dose of 0.25 mg of Conbercept, the disease regression rate is currently on average 83%, with an average recurrence rate of 15.24%, the peak of which was observed in cases of ROP in zone I. Further studies are needed to prove safety at long term, because,at the moment, only short-term data are available.
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Affiliation(s)
- Alfredo Beccasio
- Department of Medicine and Surgery, Section of Ophthalmology, S. Maria della Misericordia Hospital, 60250University of Perugia, Perugia, Italy
| | - Costanza Mignini
- Pediatric Clinic, Department of Medicine and Surgery, 18633Università degli Studi di Perugia, Perugia, Italy
| | - Anna Caricato
- Department of Medicine and Surgery, Section of Ophthalmology, S. Maria della Misericordia Hospital, 60250University of Perugia, Perugia, Italy
| | - Barbara Iaccheri
- Department of Medicine and Surgery, Section of Ophthalmology, S. Maria della Misericordia Hospital, 60250University of Perugia, Perugia, Italy
| | - Giuseppe Di Cara
- Pediatric Clinic, Department of Medicine and Surgery, 18633Università degli Studi di Perugia, Perugia, Italy
| | - Alberto Verrotti
- Pediatric Clinic, Department of Medicine and Surgery, 18633Università degli Studi di Perugia, Perugia, Italy
| | - Carlo Cagini
- Department of Medicine and Surgery, Section of Ophthalmology, S. Maria della Misericordia Hospital, 60250University of Perugia, Perugia, Italy
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13
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Eftekhari Milani A, Bagheri M, Niyousha MR, Rezaei L, Hazeri S, Safarpoor S, Abdollahi M. Comparison of Clinical Outcomes of Intravitreal Bevacizumab and Aflibercept in Type 1 Prethreshold Retinopathy of Prematurity in Posterior Zone II. J Curr Ophthalmol 2022; 34:87-92. [PMID: 35620366 PMCID: PMC9128430 DOI: 10.4103/joco.joco_193_21] [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: 06/15/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of intravitreal injection (IVI) of bevacizumab (IVB) versus aflibercept (IVA) in premature infants with type 1 prethreshold retinopathy of prematurity (ROP) in the posterior Zone II. Methods The study was a multicenter, historical cohort of premature newborns diagnosed with type 1 prethreshold ROP in the posterior Zone II, treated with IVB or IVA. Demographic features, complications, and treatment outcomes were then compared between the two groups. Results Seventy-six patients received aflibercept (the IVA group), and 210 received bevacizumab (the IVB group). The two groups were not significantly different in terms of postmenstrual age (PMA) at the time of ROP diagnosis and other known risk factors for ROP development and progression. All eyes in both the groups responded to IVI; however, recurrence was observed in four eyes (1.9%) in the IVB group and 12 (15.8%) in the IVA group (P = 0.001). Recurrence occurred 9.1 ± 0.83 (5-12) and 15.5 ± 0.98 (12-18) weeks after primary treatment in the IVB and IVA groups, respectively (P = 0.000). In the IVA group, retinal vascularization was completed in 38.18 ± 6.5 weeks (21-48) after IVI, and it happened in 23.86 ± 9.3 weeks (13-60) in the IVB group (P = 0.009). Furthermore, vascularization reached the peripheral retina in 73.25 ± 6.5 (56-84) and 58.75 ± 8.8 (45-93) weeks, PMA in the IVA and IVB groups, respectively (P = 0.03). No acute postoperative complications were observed in the treated eyes in either group. Conclusion This study shows that both IVA and IVB are effective and well tolerated for the management of type 1 prethreshold ROP in the posterior Zone II; however, IVA needs a significantly longer time for vascularization completion and has a higher recurrence rate compared with IVB.
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Affiliation(s)
- Amir Eftekhari Milani
- Department of Ophthalmology, Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masood Bagheri
- Department of Ophthalmology, Imam Khomeini Eye Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohamad Reza Niyousha
- Department of Ophthalmology, Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Rezaei
- Department of Ophthalmology, Imam Khomeini Eye Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Somayyeh Hazeri
- Department of Biology, Corcordia University, Montreal, Canada
| | - Samad Safarpoor
- Department of Ophthalmology, Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Abdollahi
- Department of Ophthalmology, Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
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14
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Riazi-Esfahani H, Mahmoudi A, Sanatkar M, Farahani AD, Bazvand F. Comparison of aflibercept and bevacizumab in the treatment of type 1 retinopathy of prematurity. Int J Retina Vitreous 2021; 7:60. [PMID: 34645516 PMCID: PMC8513371 DOI: 10.1186/s40942-021-00334-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/02/2021] [Indexed: 11/12/2022] Open
Abstract
Background To evaluate the outcome of intravitreal bevacizumab (IVB) and aflibercept (IVA) injection for patients with retinopathy of prematurity (ROP). Methods In this single-center retrospective cohort, the recorded medical data of the infants who had been undergone intravitreal injection with either bevacizumab or aflibercept for type 1 ROP were reviewed. The infants were allocated into two groups. IVB group included patients who were treated with bevacizumab as initial treatment and the IVA group included patients who were treated with aflibercept as initial treatment. The rate and time of complete regression, as well as the recurrence rates, were compared between the groups. Results A total of 889 eyes of 453 infants were enrolled in the study. There were 865 eyes of 441 infants in the IVB group and 24 eyes of 12 infants in the IVA group. Follow-up time was 289 ± 257 days in the IVB group and 143 ± 25 days in the IVA group (p < 0.001). The difference in the ROP zone was not statistically significant between the 2 treatment groups (p = 0.328). All eyes in the IVA group showed initial regression of ROP after the intravitreal injections. These regressions were achieved in 830 (96.0%) eyes that were injected with IVB (p = 0.023). The median observed regression time was 10 days and 16 days in eyes treated with bevacizumab and aflibercept respectively. Recurrence was noted in 3.9% of eyes (34/865) in the IVB group and 58.3% of eyes (14/24) in the IVA group (p < 0.001). Conclusion While the regression rate in the IVA group was significantly higher than in the IVB group, the recurrence rate was significantly more in the IVA group, which may be attributed to differences in the pharmacokinetics of these drugs in the vitreous body.
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Affiliation(s)
- Hamid Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Alireza Mahmoudi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mehdi Sanatkar
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Afsar Dastjani Farahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Fatemeh Bazvand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran.
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15
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize complications of treatment for retinopathy of prematurity (ROP) and to compare complications of laser and intravitreal antivascular endothelial growth factor (VEGF) injections. RECENT FINDINGS Poor structural outcomes and myopia are more common with laser for severe ROP than with anti-VEGF. Clinical trial data show unfavourable outcomes in 9.1-9.5% of laser treated, and 1.4-3.6% of anti-VEGF treated eyes. Additional randomized trial data show risk for very high myopia (≥-8.00D) to be 3.8 and 51.4% for zone I eyes treated with bevacizumab and laser, respectively. However, anti-VEGF may be complicated by late recurrence and is more likely to require retreatment than laser. Laser often necessitates general anaesthesia with its attendant risks, including worse short-term respiratory outcomes. Neurodevelopmental complications have been reported with anti-VEGF, but existing studies are subject to bias. SUMMARY Treatment complications are substantially different for the two modalities in common use today. In more severe cases, risk of poor structural outcome and myopia favour treatment with anti-VEGF. In less severe ROP, risk of recurrence and the need for additional treatments may favour laser. Additional data are needed to establish comparative risks of neurodevelopmental complications.
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Affiliation(s)
- Joshua M Barnett
- The Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, USA
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16
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Gangwe AB, Agrawal D, Gangrade AK, Parchand SM, Agrawal D, Azad RV. Outcomes of early versus deferred laser after intravitreal ranibizumab in aggressive posterior retinopathy of prematurity. Indian J Ophthalmol 2021; 69:2171-2176. [PMID: 34304203 PMCID: PMC8482928 DOI: 10.4103/ijo.ijo_3016_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: The aim of this study was to report the treatment outcomes of early and deferred laser in infants of aggressive posterior retinopathy of prematurity (APROP) after initial treatment with intravitreal Ranibizumab (IVR). Methods: In a prospective, randomized, interventional study, infants with APROP received IVR (0.25 mg) and were randomized into two groups prior to laser. Laser was done at 1 week (group 1) or at 6 weeks or earlier if there was a recurrence of plus disease (group 2). The structural outcome, number of laser spots, duration of laser procedure and refractive error at 6 months were compared. Favorable structural outcome was defined as, complete regression of disease at 6 weeks after laser. Results: 63 eyes of 32 infants with APROP were enrolled. Mean gestational age (GA) and birth weight (BW) were 30.2 ± 2.3 weeks and 1294 ± 372.8 grams respectively. GA, BW, and disease severity were comparable at baseline. 27 (90%) eyes in group 1 and 29 (93.5%) eyes in group 2 had favorable structural outcome (P = 0.61) at 6 weeks after laser. Eyes in group 2 (2149.8 ± 688.7) required lesser number of laser spots than group 1 (2570.8 ± 615) (P = 0.01). At six months, more eyes in group 1 had myopic refractive error (Mean spherical equivalent: –1.0D ± 1.3) than those in group 2 (Mean spherical equivalent: 0.5D ± 1.9) (P = 0.002). Conclusion: Infants with APROP receiving IVR have comparable structural outcomes after an early or deferred laser. Moreover, eyes undergoing deferred laser require less number of laser spots and have a less myopia at 6 months after laser.
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Affiliation(s)
- Anil Babanrao Gangwe
- Consultant Vitreo Retina Services, Vitreoretina Services, Raipur, Chhattisgarh, India
| | | | | | | | - Deepanshu Agrawal
- Consultant Vitreo Retina Services, Vitreoretina Services, Raipur, Chhattisgarh, India
| | - Raj Vardhan Azad
- Professor of Ophthalmology, Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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17
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Cheng Y, Zhu X, Linghu D, Liang J. Comparison of the effectiveness of conbercept and ranibizumab treatment for retinopathy of prematurity. Acta Ophthalmol 2020; 98:e1004-e1008. [PMID: 32385940 DOI: 10.1111/aos.14460] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the effectiveness of intravitreal conbercept and ranibizumab treatment for retinopathy of prematurity (ROP). METHODS In this retrospective study, the date of patients with ROP treated with intravitreal conbercept or ranibizumab from July 2012 to March 2018 with at least 12 months of follow-up at the Eye Center in People's Hospital of Peking University were analysed. Regression, progression or recurrence and peripheral retina vascularization were evaluated. RESULTS In total, 283 eyes (145 infants) with conbercept treatment and 916 eyes (480 infants) with ranibizumab treatment were enrolled. In zone I ROP and aggressive posterior ROP (APROP), the recurrence prevalence was 49.09% (108/220 eyes) and 28.57% (10/33 eyes), and the recurrence interval was 7.87 ± 0.65 (5.5-9.5) weeks and 10.6 ± 1.53 (10.5-13) weeks in the ranibizumab and conbercept groups, respectively. In zone II ROP disease, the recurrence prevalence was 23.56% (164/696 eyes) and 13.31% (33/248 eyes), and the interval of recurrence was 8.40 ± 0.88 (6-10.5) weeks and 11.4 ± 1.35 (11-13.5) weeks in the ranibizumab and conbercept groups, respectively. The recurrence prevalence was significantly higher with ranibizumab in Zone I ROP and APROP (p = 0.006) and Zone II ROP (p < 0.001), and the recurrence interval was significantly longer in the conbercept group than that in the ranibizumab (p < 0.001). There was no significant difference in the rate of retinal vascularization (p = 0.441). CONCLUSION Conbercept and ranibizumab are effective for treating ROP. Compared with ranibizumab, conbercept resulted in less recurrence and longer treatment intervals.
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Affiliation(s)
- Yong Cheng
- Peking University People’s Hospital Eye diseases and Optometry Institute Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases Department of Ophthalmology & Clinical Centre of Optometry College of Optometry Peking University Health Science Center Beijing China
| | - Xuemei Zhu
- Peking University People’s Hospital Eye diseases and Optometry Institute Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases Department of Ophthalmology & Clinical Centre of Optometry College of Optometry Peking University Health Science Center Beijing China
| | - Dandan Linghu
- Peking University People’s Hospital Eye diseases and Optometry Institute Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases Department of Ophthalmology & Clinical Centre of Optometry College of Optometry Peking University Health Science Center Beijing China
| | - Jianhong Liang
- Peking University People’s Hospital Eye diseases and Optometry Institute Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases Department of Ophthalmology & Clinical Centre of Optometry College of Optometry Peking University Health Science Center Beijing China
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18
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Daruich A, Bremond-Gignac D, Behar-Cohen F, Kermorvant E. [Retinopathy of prematurity: from prevention to treatment]. Med Sci (Paris) 2020; 36:900-907. [PMID: 33026333 DOI: 10.1051/medsci/2020163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Retinopathy of prematurity (ROP) is one of the leading cause of preventable blindness in children. Its incidence increases with increasing survival of extremely preterm babies. ROP results from a multifactorial impairment of retinal development, the retinal vascular network, involving both oxygen-dependent and nutritional factors. The numerous factors involved in ROP development suggest that preventive strategies should be synergistic and complementary, including tight control of oxygen therapy, optimized nutritional intakes and postnatal growth, breastfeeding, adequate ω-3 PUFAs supply and control of hyperglycemic episodes associated with prematurity. ROP requires a multidisciplinary management, which includes systematic screening, appropriate treatment and long-term follow-up. Current screening modalities are based on wide-field digital retinal imaging systems, which also allow screening by telemedicine. The gold-standard treatment for ROP remains laser photocoagulation. It may be combined with intravitreal anti-VEGF administration, which is currently being evaluated, or surgery for advanced stages.
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Affiliation(s)
- Alejandra Daruich
- Service d'ophtalmologie, Hôpital universitaire Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France - Inserm, UMRS1138, Équipe 17, Université Sorbonne Paris Cité, Centre de recherche des Cordeliers, 15 rue de l'École de Médecine, 75006 Paris, France - Université de Paris, Paris, France
| | - Dominique Bremond-Gignac
- Service d'ophtalmologie, Hôpital universitaire Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France - Inserm, UMRS1138, Équipe 17, Université Sorbonne Paris Cité, Centre de recherche des Cordeliers, 15 rue de l'École de Médecine, 75006 Paris, France - Université de Paris, Paris, France
| | - Francine Behar-Cohen
- Inserm, UMRS1138, Équipe 17, Université Sorbonne Paris Cité, Centre de recherche des Cordeliers, 15 rue de l'École de Médecine, 75006 Paris, France - Université de Paris, Paris, France - Ophtalmopole, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Elsa Kermorvant
- Inserm, UMRS1138, Équipe 17, Université Sorbonne Paris Cité, Centre de recherche des Cordeliers, 15 rue de l'École de Médecine, 75006 Paris, France - Université de Paris, Paris, France - Service de pédiatrie et réanimation néonatales, AP-HP, Hôpital universitaire Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France
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19
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Shafiq A, Hillier R, Hearn R. Contralateral effect of systemic absorption of low dose bevacizumab (Avastin) after unilateral intravitreal injection in severe retinopathy of prematurity (ROP). BMJ Case Rep 2020; 13:13/3/e232359. [DOI: 10.1136/bcr-2019-232359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An extremely premature baby boy born at 23 weeks’ gestational age was treated with unilateral low dose of 0.16 mg/0.025 mL intravitreal bevacizumab in the left eye for aggressive retinopathy of prematurity (ROP). He developed photographically documented changes in his contralateral right eye on imaging 5 days later. Second eye treatment was at 12 days. He has development assessment and ophthalmic review beyond age 2, which is normal. Systemic absorption of the drug caused an end organ effect to slow down and reverse ROP in his untreated right eye. Both eyes vascularised fully. His normal Bayley III developmental score at age 2 is uncommon for a 23-week gestation baby. Even at a low dose, bevacizumab has the potential for end organ effect on the second eye, and therefore other organs. In this case, there are no medium-term measurable neurodevelopmental side-effects. We suggest longer term follow-up is required before excluding unwanted side-effects.
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20
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Patel SN, Klufas MA. Evidence to date: ranibizumab and its potential in the treatment of retinopathy of prematurity. Eye Brain 2019; 11:25-35. [PMID: 31693715 PMCID: PMC6711562 DOI: 10.2147/eb.s189684] [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] [Received: 05/14/2019] [Accepted: 07/25/2019] [Indexed: 12/21/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a leading and preventable cause of childhood blindness worldwide. Although laser photocoagulation remains the gold standard for treatment, the off-label use of anti-vascular endothelial growth factor (anti-VEGF) therapy to treat ROP, particularly posterior zone I disease, is increasing. Although initial studies on anti-VEGF therapy for ROP have focused on bevacizumab, recent studies have proposed that ranibizumab may be a safer and more effective alternative for use in this population. This review updates recent evidence regarding the use of ranibizumab in the management of ROP.
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Affiliation(s)
- Samir N Patel
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael A Klufas
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
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21
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Meng QY, Cheng Y, Zhao MW, Liang JH. The process of retinal vascularization in retinopathy of prematurity after ranibizumab treatment in China. Int J Ophthalmol 2019; 12:1146-1150. [PMID: 31341806 DOI: 10.18240/ijo.2019.07.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/28/2019] [Indexed: 02/02/2023] Open
Abstract
AIM To explore the process of retinal vascularization and risk factors for retinopathy of prematurity (ROP) treated with intravitreal ranibizumab (IVR) as monotherapy. METHODS Infants with type 1 ROP who received IVR as primary treatment from August 2014 to October 2016 at Peking University People's Hospital's Ophthalmology Department were included in the study. All eyes received 0.25 mg ranibizumab at initial treatment. Retinal vascularization was evaluated clinically. Potential risk factors were also recorded and examined. RESULTS Retinal vascularization was completed in 126 eyes (62.7%), and retinal vascularization terminated in zone II and zone III with 16 eyes (7.9%) and 44 eyes (21.9%), respectively, after more than 1-year follow-up. In multivariate regression analysis, lower birth weight (BW), severity of ROP and repeated injections were found to be risk factors for peripheral avascular area (P<0.05). CONCLUSION In our retrospective study, 29.8% of the ROP eyes treated with ranibizumab have peripheral avascular area at the last follow-up. Lighter BW and the severity of ROP are risk factors. Furthermore, repeated injections also increase the risk of retinal peripheral avascular area remaining in ROP patients.
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Affiliation(s)
- Qing-Yu Meng
- Department of Ophthalmology & Clinical Center of Optometry, Peking University People's Hospital, Beijing 100044, China.,Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing 100044, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China.,College of Optometry, Peking University Health Science Center, Beijing 100191, China
| | - Yong Cheng
- Department of Ophthalmology & Clinical Center of Optometry, Peking University People's Hospital, Beijing 100044, China.,Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing 100044, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China.,College of Optometry, Peking University Health Science Center, Beijing 100191, China
| | - Ming-Wei Zhao
- Department of Ophthalmology & Clinical Center of Optometry, Peking University People's Hospital, Beijing 100044, China.,Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing 100044, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China.,College of Optometry, Peking University Health Science Center, Beijing 100191, China
| | - Jian-Hong Liang
- Department of Ophthalmology & Clinical Center of Optometry, Peking University People's Hospital, Beijing 100044, China.,Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing 100044, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China.,College of Optometry, Peking University Health Science Center, Beijing 100191, China
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22
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Cheng Y, Liu TG, Li WY, Zhao MW, Liang JH. Fluorescein angiography of retinal vascular involution after intravitreal injection of ranibizumab for retinopathy of prematurity. Int J Ophthalmol 2019; 12:79-82. [PMID: 30662844 PMCID: PMC6326942 DOI: 10.18240/ijo.2019.01.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/11/2018] [Indexed: 02/03/2023] Open
Abstract
AIM To describe the involution patterns of vessel growth of retina through fluorescein angiography (FA) of children, who had been under treatment up to 1y previously intravitreal ranibizumab (IVR) as monotherapy for retinopathy of prematurity (ROP). METHODS This is a retrospective study. The medical information and FA of 17 children (34 eyes) whose area of avascular retina from the ora serrata was more than two disc diameters (DD) were analyzed. RESULTS Among 34 eyes, all were the presence of finger-shaped vessels and arteriolar-venular shunts (100%, 34/34 eyes). Popcorn abnormalities were found in most of the eyes (94.1%, 32/34 eyes). Furthermore, in many cases (23.5%, 8/34 eyes), there were leakage persisting in the region of the junction between avascular and vascular retina. In contrast, just 2 eyes (5.9%) showed damage of retinal capillary bed and 3 eyes (8.8%) showed large area of retinal pigment epithelium (RPE) atrophy. CONCLUSION Although IVR can be very effective in ROP, we should remain cautious as infants may remain avascular peripheral retinas and abnormal vessel. FA allows accurate visualization of vessel abnormalities in eyes with ROP, which will be helpful to affect assessment of disease activity and therapeutic effect.
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Affiliation(s)
- Yong Cheng
- Department of Ophthalmology, Peking University People's Hospital, Beijing 100044, China
- Eye diseases and Optometry Institute, Beijing 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
- College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Tie-Gang Liu
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China
- Tianjin Eye Hospital, Tianjin 300020, China
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
- Tianjin Eye Institute, Tianjin 300020, China
- Department of Ophthalmology, Beijing Capital International Airport Hospital, Beijing 100621, China
| | - Wei-Yi Li
- Department of Ophthalmology, Peking University People's Hospital, Beijing 100044, China
- Eye Hospital, China Academy of Chinese Medical Sciences, Beijing 100040, China
| | - Ming-Wei Zhao
- Department of Ophthalmology, Peking University People's Hospital, Beijing 100044, China
- Eye diseases and Optometry Institute, Beijing 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
- College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Jian-Hong Liang
- Department of Ophthalmology, Peking University People's Hospital, Beijing 100044, China
- Eye diseases and Optometry Institute, Beijing 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
- College of Optometry, Peking University Health Science Center, Beijing 100044, China
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Comparison of clinical outcomes of intravitreal ranibizumab and aflibercept treatment for retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 2018; 257:49-55. [DOI: 10.1007/s00417-018-4168-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/08/2018] [Accepted: 10/16/2018] [Indexed: 01/19/2023] Open
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Bai Y, Nie H, Wei S, Lu X, Ke X, Ouyang X, Feng S. Efficacy of intravitreal conbercept injection in the treatment of retinopathy of prematurity. Br J Ophthalmol 2018; 103:494-498. [PMID: 30030391 DOI: 10.1136/bjophthalmol-2017-311662] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/03/2018] [Accepted: 05/30/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND To evaluate the safety and efficacy of intravitreal conbercept (IVC) injection in the treatment of retinopathy of prematurity (ROP). METHODS Patients with ROP who underwent IVC injection in Zhujiang Hospital from June 2015 to July 2016 were studied retrospectively. The primary outcome was defined as the regression of plus disease. The secondary outcomes were defined as the presence of recurrence, number of injections and the final regression of disease. RESULTS A total of 48 eyes of 24 patients with ROP were included. Among them, 9 eyes of 5 patients had zone I ROP, 35 eyes of 18 patients had zone II ROP and 4 eyes of 2 patients had aggressive posterior ROP. The mean gestational age was 28.5±1.6 weeks, the mean birth weight was 1209.6±228.6 g, the mean postmenstrual age of first injection was 34.2±1.9 weeks and the mean follow-up period was 31.0±4.7 weeks. Forty of 48 eyes (83.3%) received IVC only once, and the regression of plus disease occurred at an average of 3.5±1.5 weeks after the first injection of conbercept. For eight recurrent eyes (16.7%), four eyes received a second IVC and the remaining four eyes received laser photocoagulation, and the regression of plus disease occurred in 3 weeks. No lens opacity, vitreous haemorrhage, entophthalmia or retinal detachment was observed during follow-up. CONCLUSION IVC injection is an effective treatment for ROP.
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Affiliation(s)
- Yichen Bai
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Huanjie Nie
- Department of Gynecology, Liwan Chinese Traditional Medicine Hospital, Guangzhou, China
| | - Shiyu Wei
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaohe Lu
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyun Ke
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xuejun Ouyang
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Songfu Feng
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Sankar MJ, Sankar J, Chandra P. Anti-vascular endothelial growth factor (VEGF) drugs for treatment of retinopathy of prematurity. Cochrane Database Syst Rev 2018; 1:CD009734. [PMID: 29308602 PMCID: PMC6491066 DOI: 10.1002/14651858.cd009734.pub3] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) plays a key role in angiogenesis in foetal life. Researchers have recently attempted to use anti-VEGF agents for the treatment of retinopathy of prematurity (ROP), a vasoproliferative disorder. The safety and efficacy of these agents in preterm infants with ROP is currently uncertain. OBJECTIVES To evaluate the efficacy and safety of anti-VEGF drugs when used either as monotherapy, that is without concomitant cryotherapy or laser therapy, or in combination with planned cryo/laser therapy in preterm infants with type 1 ROP (defined as zone I any stage with plus disease, zone I stage 3 with or without plus disease, or zone II stage 2 or 3 with plus disease). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 11), MEDLINE (1966 to 11 December 2016), Embase (1980 to 11 December 2016), CINAHL (1982 to 11 December 2016), and conference proceedings. SELECTION CRITERIA Randomised or quasi-randomised controlled trials that evaluated the efficacy or safety of administration, or both, of anti-VEGF agents compared with conventional therapy in preterm infants with ROP. DATA COLLECTION AND ANALYSIS We used standard Cochrane and Cochrane Neonatal methods for data collection and analysis. We used the GRADE approach to assess the quality of the evidence. MAIN RESULTS Six trials involving a total of 383 infants fulfilled the inclusion criteria. Five trials compared intravitreal bevacizumab (n = 4) or ranibizumab (n = 1) with conventional laser therapy (monotherapy), while the sixth study compared intravitreal pegaptanib plus conventional laser therapy with laser/cryotherapy (combination therapy).When used as monotherapy, bevacizumab/ranibizumab did not reduce the risk of complete or partial retinal detachment (3 studies; 272 infants; risk ratio (RR) 1.04, 95% confidence interval (CI) 0.21 to 5.13; risk difference (RD) 0.00, 95% CI -0.04 to 0.04; very low-quality evidence), mortality before discharge (2 studies; 229 infants; RR 1.50, 95% CI 0.26 to 8.75), corneal opacity requiring corneal transplant (1 study; 286 eyes; RR 0.34, 95% CI 0.01 to 8.26), or lens opacity requiring cataract removal (3 studies; 544 eyes; RR 0.15, 95% CI 0.01 to 2.79). The risk of recurrence of ROP requiring retreatment also did not differ between groups (2 studies; 193 infants; RR 0.88, 95% CI 0.47 to 1.63; RD -0.02, 95% CI -0.12 to 0.07; very low-quality evidence). Subgroup analysis showed a significant reduction in the risk of recurrence in infants with zone I ROP (RR 0.15, 95% CI 0.04 to 0.62), but an increased risk of recurrence in infants with zone II ROP (RR 2.53, 95% CI 1.01 to 6.32). Pooled analysis of studies that reported eye-level outcomes also revealed significant increase in the risk of recurrence of ROP in the eyes that received bevacizumab (RR 5.36, 95% CI 1.22 to 23.50; RD 0.10, 95% CI 0.03 to 0.17). Infants who received intravitreal bevacizumab had a significantly lower risk of refractive errors (very high myopia) at 30 months of age (1 study; 211 eyes; RR 0.06, 95% CI 0.02 to 0.20; RD -0.40, 95% CI -0.50 to -0.30; low-quality evidence).When used in combination with laser therapy, intravitreal pegaptanib was found to reduce the risk of retinal detachment when compared to laser/cryotherapy alone (152 eyes; RR 0.26, 95% CI 0.12 to 0.55; RD -0.29, 95% CI -0.42 to -0.16; low-quality evidence). The incidence of recurrence of ROP by 55 weeks' postmenstrual age was also lower in the pegaptanib + laser therapy group (76 infants; RR 0.29, 95% CI 0.12 to 0.7; RD -0.35, 95% CI -0.55 to -0.16; low-quality evidence). There was no difference in the risk of perioperative retinal haemorrhages between the two groups (152 eyes; RR 0.62, 95% CI 0.24 to 1.56; RD -0.05, 95% CI -0.16 to 0.05; very low-quality evidence). However, the risk of delayed systemic adverse effects with any of the three anti-VEGF drugs is not known. AUTHORS' CONCLUSIONS Implications for practice: Intravitreal bevacizumab/ranibizumab, when used as monotherapy, reduces the risk of refractive errors during childhood but does not reduce the risk of retinal detachment or recurrence of ROP in infants with type 1 ROP. While the intervention might reduce the risk of recurrence of ROP in infants with zone I ROP, it can potentially result in higher risk of recurrence requiring retreatment in those with zone II ROP. Intravitreal pegaptanib, when used in conjunction with laser therapy, reduces the risk of retinal detachment as well as the recurrence of ROP in infants with type 1 ROP. However, the quality of the evidence was very low to low for most outcomes due to risk of detection bias and other biases. The effects on other critical outcomes and, more importantly, the long-term systemic adverse effects of the drugs are not known. Insufficient data precludes strong conclusions favouring routine use of intravitreal anti-VEGF agents - either as monotherapy or in conjunction with laser therapy - in preterm infants with type 1 ROP. IMPLICATIONS FOR RESEARCH Further studies are needed to evaluate the effect of anti-VEGF agents on structural and functional outcomes in childhood and delayed systemic effects including adverse neurodevelopmental outcomes.
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Affiliation(s)
- Mari Jeeva Sankar
- All India Institute of Medical SciencesNewborn Health Knowledge Centre, WHO Collaborating Centre for Training and Research in Newborn Care, Department of PediatricsDelhiIndia
| | - Jhuma Sankar
- All India Institute of Medical SciencesDepartment of PediatricsNew DelhiNew DelhiIndia
| | - Parijat Chandra
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS)New DelhiDelhiIndia110029
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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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