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[Retinopathy of the premature: Update in screening and treatment]
Aldo Bancalari M1, Ricardo Schade2
1Departamento de Pediatría, Facultad de Medicina, Universidad de Concepción, Concepción, Chile.
Insights
Retinopathy of Prematurity (ROP) screening targets premature infants. New treatments like anti-VEGF agents and oral propranolol offer alternatives to laser photocoagulation for ROP management.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Medicine
Background:
- Retinopathy of Prematurity (ROP) is a serious vascular disorder affecting premature infants' retinas.
- It primarily impacts very-low-birth-weight (VLBW) infants and those born before 32 weeks gestational age.
Purpose of the Study:
- To define screening criteria for ROP.
- To review recent advancements in ROP treatment over the past decade.
Main Methods:
- Review of current literature on ROP screening and treatment.
- Analysis of emerging therapies including anti-VEGF agents and oral propranolol.
Main Results:
- ROP screening is crucial for VLBW infants and neonates < 32 weeks gestational age.
- Anti-VEGF agents show promise for threshold ROP in Zone I, with fewer adverse effects than laser photocoagulation.
- Oral propranolol is being investigated for pre-threshold ROP, potentially preventing progression and reducing the need for invasive treatments.
Conclusions:
- Laser photocoagulation remains a standard ROP treatment.
- Anti-VEGF agents and oral propranolol represent significant new therapeutic options for ROP.
- These novel treatments may prevent ROP progression and improve long-term ocular outcomes.
Abstract:
Retinopathy of Prematurity (ROP) is a proliferative disorder of the blood vessels of the immature retina, which affects mainly very-low-birth-weight infants (VLBW). The objective of this review is to describe to which infant the screening examination of this disease should be performed and to analy ze the recent advances in the treatment of this disease, which have emerged in the last decade. The detection of this disease is mainly focused on VLBW infants and newborns < 32 weeks of gestational age. In addition to laser photocoagulation, standard treatment today, new therapies have appeared, such as the anti-VEGF agents, which have been successfully used in the threshold ROP, especially located in zone I. This therapy is less harmful than laser photocoagulation and with better ocular results in the future. In recent years, oral propranolol has been used as a treatment for ROP in clinical trials, mainly in the pre-threshold stage (stage 2 or 3 in zone II or III). This drug is a beta-adrenergic blocker that can prevent the progression of retinopathy in pre-threshold to threshold stage and/or avoid the need for invasive therapies, such as laser photocoagulation or intravitreal administration of anti-VEGF agents. Laser photocoagulation continues to be the standard treatment for ROP. New treatments have emerged for ROP, such as anti-VEGF agents and oral propranolol, which could pre vent the progression of this disease from the pre-threshold to the threshold stage.
