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Updated: Oct 6, 2025
Intravitreal Injections in the Ovine Eye
Published on: July 5, 2022
New trends in intravitreal anti-VEGF therapy for ROP
Alfredo Beccasio1, Costanza Mignini2, Anna Caricato1
1Department of Medicine and Surgery, Section of Ophthalmology, S. Maria della Misericordia Hospital, 60250University of Perugia, Perugia, Italy.
Insights
Anti-VEGF drugs effectively treat Retinopathy of Prematurity (ROP) in premature infants, reducing recurrence rates. However, long-term safety data for these treatments are still limited.
Area of Science:
- Ophthalmology
- Neonatology
- Pharmacology
Background:
- Retinopathy of Prematurity (ROP) is a significant cause of childhood blindness in premature newborns.
- Vascular Endothelial Growth Factor (VEGF) plays a crucial role in ROP pathogenesis.
- Intravitreal anti-VEGF therapies have emerged as a key treatment strategy for ROP.
Purpose of the Study:
- To evaluate the efficacy and recurrence rates of various intravitreal anti-VEGF drugs used in ROP treatment.
- To compare the effectiveness of different anti-VEGF agents and their associated recurrence rates.
Main Methods:
- Systematic review and extrapolation of data from existing studies on anti-VEGF drug efficacy in ROP.
- Analysis of regression rates and recurrence rates for Pegabtanib, Ranibizumab, Aflibercept, and Conbercept.
Main Results:
- Pegabtanib combined with laser photocoagulation showed high efficacy (89.7%) and low recurrence (14.6%).
- Ranibizumab demonstrated over 75% efficacy but had the highest recurrence rate (41.5%), especially in Aggressive Posterior ROP (APROP).
- Aflibercept (81.9% efficacy, 28.9% recurrence) and Conbercept (83% efficacy, 15.24% recurrence) also showed significant efficacy with varying recurrence rates.
Conclusions:
- Intravitreal anti-VEGF agents are effective in treating ROP, with notable differences in recurrence rates among drugs.
- Combination therapy with Pegabtanib and laser photocoagulation appears highly effective with low recurrence.
- Further long-term safety studies are essential for these anti-VEGF treatments, as current data is limited to short-term outcomes.
Abstract:
Retinopathy of Prematurity (ROP) affects premature newborns, and it can cause childhood blindness and visual impairment if untreated. The understanding of the pathogenetic role of Vascular Endothelial Growth Factor (VEGF) has led to development of therapeutic strategies such as intravitreal anti-VEGF drugs. We reported drug efficacy and ROP recurrence rates, extrapolated from the reviewed studies. Association of Pegabtanib and laser photocoagulation confers efficacy in the regression of ROP stage 3 plus in zone I / II in 89.7% of treated eyes, reducing the recurrence rate to 14.6% compared to 50% of laser therapy alone. Irrespective of the dose, Ranibizumab demonstrated average efficacy greater than 75% on regression of active disease with the highest rates of the dose of 0.1 mg (92.5%). The recurrence, on the other hand, is the highest among this new anti-VEGF agents and is around an average of 41.5%, which records the highest values in the case of Aggressive Posterior Rop (APROP). Aflibercept at a dose of 1 mg demonstrated average efficacy of about 81.9% of treated infants, analyzing significantly fewer studies than Ranibizumab. The recurrence rate stands at an average of 28.9%, especially in the later forms of ROP. Using a dose of 0.25 mg of Conbercept, the disease regression rate is currently on average 83%, with an average recurrence rate of 15.24%, the peak of which was observed in cases of ROP in zone I. Further studies are needed to prove safety at long term, because,at the moment, only short-term data are available.
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