Antivascular Endothelial Growth Factor in the Treatment of Retinopathy of Prematurity

Jinali R. Patel; Sinthu S. Ranjan; Barry N. Wasserman

Disclosures

Curr Opin Ophthalmol. 2016;27(5):387-392. 

In This Article

Abstract and Introduction

Abstract

Purpose of review To review the most recent literature regarding the clinical experience of antivascular endothelial growth factor (anti-VEGF) therapies in the treatment of retinopathy of prematurity (ROP).

Recent findings Anti-VEGF agents in stage 3+ and aggressive posterior ROP have been shown to induce rapid ROP regression. However, significant reoccurrence rates can require repeat injections and thus longer term and more frequent follow-up. Initial studies reflect conflicting evidence regarding significant systemic side effects of these treatments, and outcomes in these patients past the first few years of life are yet to be definitively determined.

Summary Although anti-VEGF therapies show promise in the treatment of ROP, frequent reoccurrences and lack of thorough data about long-term side effects of pharmacologic intervention necessitate further research before anti-VEGF agents become the mainstay of ROP management.

Introduction

Retinopathy of prematurity (ROP) is a devastating vascular proliferative disorder that causes a spectrum of clinical disease in preterm infants and can result in blindness. Until the 1990s, cryotherapy was the first-line therapy for the management of ROP. The multicenter trial of cryotherapy for ROP demonstrated that cryotherapy produced less adverse outcomes as compared with controls, and the impact was sustained at 10-year follow-up.[1]

In the late 1990s and 2000s, cryotherapy was replaced by laser photocoagulation. Studies comparing cryotherapy with laser photocoagulation found that patients treated with cryotherapy had significantly higher myopia compared with patients treated with laser.[2] This research led to a shift in primary therapy, and laser photocoagulation became the gold standard of ROP treatment. Although better tolerated than cryotherapy, laser photocoagulation has side effects, including reduction of the visual field, retinal hemorrhage, myopia, and cataract formation.[3] More recently, antivascular endothelial growth factor (VEGF) agents, which pharmacologically modify the course of this pathologic retinal vascularization, have shown significant promise. The 2011 hallmark study of anti-VEGF therapy in ROP, the efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity (BEAT-ROP), found that in infants with zone 1 stage 3+ disease, the recurrence rate of ROP in patients treated with bevacizumab was 4% compared with 22% with traditional laser therapy, lending support to the use of this new treatment modality.[4]

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