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Published on: April 2, 2021
Treatment of retinopathy of prematurity with vascular endothelial growth factor inhibitors
1Department of Ophthalmology and Visual Science, University of Texas Health Science Center, Houston Medical School, 6400 Fannin Street, Suite 1800, Houston, TX 77030-1526, USA. Helen.A.Mintz-Hittner@uth.tmc.edu
Insights
Vascular endothelial growth factor inhibitors (anti-VEGF) show promise for treating severe retinopathy of prematurity (ROP) in premature infants. Further research is needed to confirm optimal dosing and long-term safety.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Medicine
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness globally.
- Severe ROP, particularly in zone 1, often presents challenges with current laser therapy.
- Understanding ROP pathogenesis has led to novel therapeutic approaches.
Purpose of the Study:
- To discuss the controversial yet effective use of anti-VEGF agents in severe ROP.
- To evaluate the documented efficacy, local complications, and potential systemic toxicities of anti-VEGF therapy.
- To explore the benefits and risks of anti-VEGF for preserving vision in severe zone 1 ROP.
Main Methods:
- Review of current literature and clinical observations regarding anti-VEGF use in ROP.
- Analysis of treatment timing based on VEGF levels in retinal and vitreous samples.
- Discussion of dose-finding and drug-selection considerations for anti-VEGF therapy.
Main Results:
- Anti-VEGF therapy has demonstrated efficacy in retaining vision for severe zone 1 ROP.
- Local complications have been observed, though systemic toxicities have not been reported in a six-year period.
- The precise dosage and ideal drug for interrupting pathological neovascularization require further investigation.
Conclusions:
- Anti-VEGF agents represent a potentially vital treatment option for severe ROP, especially in cases unresponsive to laser therapy.
- Careful screening and timing of administration are crucial for effective anti-VEGF treatment.
- Long-term studies are essential to fully understand the local and systemic risks associated with anti-VEGF therapy in premature infants.
Abstract:
ROP remains a major cause of childhood blindness worldwide. The smallest, sickest infants develop the most severe forms of zone 1 ROP. Such eyes may not be successfully treated by near confluent laser to the avascular retina (current standard of care). With an understanding of ROP pathogenesis, vascular endothelial growth factor inhibitors (anti-VEGF) are being given only when VEGF is elevated in retina and vitreous. Careful screening allows proper timing of administration. Ideal dose (perhaps different for mild and severe cases) and drug (interrupting only pathologic neovascularization and not normal angiogenesis) remain unproven. The author discusses controversial use of anti-VEGF with documented efficacy, observed local complications, and potential systemic toxicities (none observed in six years) to allow retention of vision for severe zone 1 ROP. The benefits have been demonstrated, however, local and systemic risks in these developing premature infants must be carefully studied (both short and long term).
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