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Retinopathy of prematurity: the need for prevention
Raffael Liegl1, Ann Hellström2, Lois Eh Smith1
1Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Preventing retinopathy of prematurity (ROP) may be possible by mimicking the intrauterine environment. Insulin growth factor 1 supplementation is a promising strategy to prevent ROP and other infant complications.
Area of Science:
- Neonatology
- Ophthalmology
- Developmental Biology
Background:
- Retinopathy of prematurity (ROP) is a major cause of childhood blindness in premature infants.
- Current treatments like laser photocoagulation and anti-VEGF injections manage late-stage ROP but do not prevent it and have limitations.
Purpose of the Study:
- To review current knowledge on preventing ROP.
- To emphasize the potential of insulin growth factor 1 (IGF-1) supplementation for ROP prevention.
Main Methods:
- Literature review of ROP pathogenesis and prevention strategies.
- Focus on intrauterine environment mimicry and IGF-1 supplementation.
Main Results:
- Laser and anti-VEGF therapies are reactive, not preventive, and carry risks.
- Mimicking the intrauterine environment by controlling oxygen and providing factors like IGF-1 shows promise for prevention.
Conclusions:
- Preventing ROP is a critical goal.
- Supplementing with IGF-1 and managing the post-birth environment may prevent ROP and other preterm complications.
Abstract:
More than 450,000 babies are born prematurely in the USA every year. The improved survival of even the most vulnerable low body weight preterm infants has, despite improving health outcomes, led to the resurgence in preterm complications including one of the major causes for blindness in children, retinopathy of prematurity (ROP). The current mainstay in ROP therapy is laser photocoagulation and the injection of vascular endothelial growth factor (VEGF) antibodies in the late stages of the disease after the onset of neovascularization. Both are proven options for ophthalmologists to treat the severe forms of late ROP. However, laser photocoagulation destroys major parts of the retina, and the injection of VEGF antibodies, although rather simple to administer, may cause a systemic suppression of normal vascularization, which has not been studied in sufficient depth. However, the use of neither VEGF antibody nor laser treatment prevents ROP, which should be the long-term goal. It should be possible to prevent ROP by more closely mimicking the intrauterine environment after preterm birth. Such preventive measures include preventing the toxic postbirth influences (eg, oxygen excess) as well as providing the missing intrauterine factors (eg, insulin growth factor 1) and are likely to also reduce other complications of premature birth as well as ROP. This review is meant to summarize the current knowledge on the prevention of ROP with a particular emphasize on the use of insulin growth factor 1 supplementation.
