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An Observational Study of Different Treatment Practices for Aggressive Posterior Retinopathy of Prematurity
Insights
For aggressive posterior retinopathy of prematurity (APROP), a combination therapy of anti-VEGF and laser treatment shows promise for infants with lower gestational age or birth weight. This approach leads to early regression and reduced recurrence rates.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Medicine
Background:
- Aggressive posterior retinopathy of prematurity (APROP) is a severe form of retinopathy of prematurity (ROP).
- Risk factors and optimal treatment strategies for APROP remain areas of active investigation.
Purpose of the Study:
- To evaluate risk factors and outcomes of different treatment modalities for APROP.
- To compare the effectiveness of anti-VEGF therapy, laser therapy, and combination therapy in managing APROP.
Main Methods:
- An observational study involving infants diagnosed with APROP.
- Patients were categorized into three groups: anti-VEGF only, laser only, and a combined anti-VEGF and laser therapy group.
- Infants were monitored for risk factors and followed for 12 weeks to assess treatment outcomes.
Main Results:
- The combined therapy group, despite presenting with lower birth weight and gestational age, showed comparable regression rates to the laser-only group.
- Disease recurrence was significantly lower in the combined therapy and laser-only groups compared to the anti-VEGF only group.
- Progression to stage 4 ROP requiring surgery occurred in two eyes treated with laser therapy alone.
Conclusions:
- Infants with APROP and risk factors like lower gestational age, lower birth weight, or prolonged ventilation may benefit from planned combination therapy.
- Combination therapy (anti-VEGF followed by laser within 2 weeks) appears to facilitate early regression, a stable disease course, and reduced recurrence.
- This approach may also lead to a larger area of retinal vascularization compared to other methods.
Purpose:
To evaluate risk factors and outcomes of preferred practice for infants with aggressive posterior retinopathy of prematurity (APROP) at a tertiary eye center in India.
Methods:
This was an observational study of infants with APROP where patients were divided into three groups after 2 weeks of initial treatment depending on the treatment received: anti-VEGF only, laser only, and combination of anti-VEGF injection followed by laser within 2 weeks of anti-VEGF injection (combined group). All infants were evaluated for risk factors and followed up at 1, 2, 4, 8, and 12 weeks to determine treatment outcomes in terms of regression, vascular re-growth, progression, and recurrence of the disease.
Results:
Sixty eyes of 31 infants were included in the study, with 26 eyes in the anti-VEGF only group, 19 eyes in the laser-only group, and 15 eyes in the combined group. Infants in the combined group presented late with lower birth weight (BW), smaller gestational age (GA), and a history of longer duration of ventilatory support. After 3 months of follow-up, regression occurred in 73.08% in the anti-VEGF only group, 89.5% in the laser-only group, and 86.66% in the combined group (P = .07). Zone of vascularization was greater in the anti-VEGF only group and the combined group compared to the laser-only group. Disease recurrence was seen in 27% in the anti-VEGF group, none in the laser-only group, and 13.33% in the combined group (P < .001). However, progression to stage 4 ROP requiring surgery was noted in 2 eyes in the laser-only group.
Conclusions:
Infants with APROP who have a lower GA or BW or require longer ventilatory support are possibly a subset best suited for planned combination therapy. A combination of anti-VEGF therapy followed by laser treatment within 2 weeks allows for early regression, a stable course, lower recurrence, and a larger area of retinal vascularization. [.
