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Time to consider a new treatment protocol for aggressive posterior retinopathy of prematurity?
Ulrich Spandau1, Zoran Tomic, Uwe Ewald
1Department of Neuroscience, University of Uppsala, Sweden.
Insights
Aggressive posterior retinopathy of prematurity (AP-ROP) treatment options were reviewed. Anti-vascular endothelial growth factor therapy is a potential alternative to laser treatment, but more research on side effects is needed.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Pediatric Surgery
Background:
- Aggressive posterior retinopathy of prematurity (AP-ROP) is a severe condition affecting premature infants.
- Traditional laser treatment for AP-ROP, especially in zone I, can have a high complication rate.
Purpose of the Study:
- To discuss and evaluate treatment modalities for aggressive posterior retinopathy of prematurity (AP-ROP).
- To compare the efficacy and complications of laser therapy versus bevacizumab injections for AP-ROP.
Main Methods:
- Retrospective review of medical charts for infants with AP-ROP treated between 2009-2010.
- Treatment modalities included laser therapy, cryopexy, and intravitreal bevacizumab injections.
- RetCam photography documented retinal appearance before and after treatment.
Main Results:
- All 16 treated eyes had AP-ROP in zone I.
- Bevacizumab was used as a first-line therapy in some cases and as salvage therapy in others.
- Macular dragging occurred in one eye treated primarily with laser therapy.
Conclusions:
- Anti-vascular endothelial growth factor (bevacizumab) treatment is a viable alternative to extensive laser therapy for zone I AP-ROP due to lower complication rates.
- Further research is necessary to understand the long-term ocular and systemic side effects of bevacizumab before widespread clinical adoption.
Purpose:
To discuss treatment modalities for aggressive posterior retinopathy of prematurity (AP-ROP).
Methods:
The medical charts of all infants with AP-ROP at Uppsala University Hospital, Sweden, during a 2-year period (2009 and 2010) were reviewed. Eight infants (16 eyes) with a mean gestational age of 23.8 weeks and a mean birth weight of 592 g were treated with laser and/or intravitreal injections of bevacizumab (0.4 and 0.625 mg). RetCam photography was used to document the retinal appearance before and after treatment.
Results:
All infants (16 eyes) had AP-ROP in zone I. Mean time at initial treatment was 34 weeks postmenstrual age. Two eyes (one infant) were only treated with laser, and six eyes (three infants) were treated with laser therapy or cryopexy and, because of lack of regression, with bevacizumab as salvage therapy. Eight eyes (four infants) were treated with a first-line bevacizumab injection and four of these eyes (two infants) with additional laser ablation for continued disease progression in zone II. Macular dragging occurred in one eye of one infant primarily treated with laser.
Conclusions:
Given the high complication rate of the extensive laser treatment for zone I ROP, it is worth considering anti-vascular endothelial growth factor treatment as an alternative therapy. Further knowledge concerning side effects and long-term ocular and systemic outcome is warranted before this drug becomes general clinical practice.
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