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Retinopathy of Prematurity: Evolving Treatment With Anti-Vascular Endothelial Growth Factor
1John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA.
Insights
Retinopathy of prematurity has evolved significantly, with treatments shifting from destructive methods to anti-VEGF agents. Future goals focus on optimizing care and developing less invasive strategies for premature infants.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Medicine
Background:
- Retinopathy of prematurity (ROP) has evolved from affecting moderately premature infants to extremely premature infants.
- Understanding of ROP pathophysiology, diagnosis, and treatment has changed significantly since its initial description.
Purpose of the Study:
- To review the evolution of retinopathy of prematurity (ROP) since its initial description.
- To analyze changes in pathophysiology, diagnosis, and treatments, including destructive, anti-VEGF, and supportive therapies.
- To explore global variations in ROP and formulate future research questions for optimized infant care.
Main Methods:
- Literature review and synthesis.
- Critical review of historical articles, pathophysiologic risk factors, and global ROP manifestations.
- Inclusion of basic and clinical science, focusing on anti-VEGF mechanisms and clinical trial data.
Main Results:
- ROP now affects extremely premature infants, a shift from earlier presentations.
- Global ROP manifestations vary, with emerging countries showing similarities to historical US cases.
- Treatments have advanced from retinal destruction to anti-VEGF agents, promoting normal vascularization and aiming for less destructive interventions.
Conclusions:
- Future goals for ROP management include optimizing prenatal/perinatal care and diagnostic accuracy worldwide.
- Refining treatment strategies, including anti-VEGF agents, is crucial to inhibit angiogenesis and support retinal vascularization.
- Emphasis is placed on supporting neural and vascular development in premature infants and their retinas.
Purpose:
To discuss the evolution in retinopathy of prematurity since its first description as retrolental fibroplasia in the United States, including the changes in the understanding of pathophysiology; methods of diagnosis; destructive, anti-vascular endothelial growth factor (anti-VEGF), and supportive treatments; and differences in retinopathy of prematurity manifestations worldwide. The overall goal is to clarify retinopathy of prematurity currently and formulate questions to optimize future care.
Study Design:
Literature review and synthesis.
Methods:
Critical review and consideration of the literature with inclusion of historical articles and those regarding pathophysiologic risk factors, retinopathy of prematurity worldwide, basic and clinical science particularly regarding anti-VEGF mechanisms and agents tested in clinical trials.
Results:
Retinopathy of prematurity has evolved from affecting infants approximately 2 months premature to affecting extremely premature infants. Worldwide, retinopathy of prematurity differs and, in emerging countries, has features similar to that experienced in the United States when retinopathy of prematurity first manifested. Treatments have evolved from destruction of the peripheral avascular retina to inhibit angiogenic stimuli to anti-VEGF agents, which inhibit pathologic angiogenesis but also extend normal intraretinal angiogenesis by ordering the development of intraretinal vessels. Clinical trial evidence is accruing with the goal to develop less destructive treatments to optimize vision and that are protective to the retina and infant.
Conclusions:
Goals for retinopathy of prematurity are to optimize prenatal and perinatal care, improve diagnostic acumen worldwide and refine treatment strategies, including with anti-VEGF agents, to inhibit intravitreal angiogenesis and facilitate vascularization of the previously avascular retina, which include supporting neural and vascular development of the premature infant and retina.
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