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Retinopathy of prematurity: Anti vascular endothelial growth factor (Anti-VEGF) or laser photocoagulation?
Arijit Lodha1, Amelie Stritzke2, Stephanie Dotchin3
1Faculty of Dentistry & Medicine, University of Alberta, Edmonton, Alberta, Canada.
Insights
Retinopathy of prematurity (ROP) is a serious eye condition in premature infants. Anti-Vascular Endothelial Growth Factor (VEGF) therapy offers a minimally invasive treatment option, but further research is needed on optimal use and long-term effects.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatrics
Background:
- Retinopathy of prematurity (ROP) affects premature infants' underdeveloped retinas, potentially causing vision loss.
- Oxygen therapy in premature infants is a risk factor for developing ROP.
- Severe ROP can lead to retinal detachment and blindness, posing a significant clinical challenge.
Purpose of the Study:
- To review the current landscape of Retinopathy of Prematurity (ROP) management.
- To highlight the role and emerging evidence of Anti-Vascular Endothelial Growth Factor (VEGF) therapy in ROP treatment.
- To identify key considerations and uncertainties in ROP screening and treatment for neonatologists and pediatricians.
Main Methods:
- Literature review of ROP screening, risk factors, and treatment modalities.
- Analysis of the benefits and limitations of Anti-VEGF therapy versus laser therapy.
- Discussion of clinical practice guidelines and ongoing research areas in ROP management.
Main Results:
- Anti-VEGF therapy presents a minimally invasive, effective treatment for significant ROP, with advantages in administration and reduced surgical needs.
- Laser therapy remains a gold standard treatment for certain ROP cases.
- Uncertainties persist regarding optimal Anti-VEGF drug selection, dosing, systemic effects, and long-term neurodevelopmental outcomes.
Conclusions:
- Anti-VEGF agents are increasingly utilized as a first-line therapy for ROP under ophthalmologist guidance.
- Effective ROP management requires a balance between treatment benefits and risks.
- Neonatal care providers must be knowledgeable about ROP to ensure timely screening and appropriate treatment for preterm infants.
Abstract:
Retinopathy of prematurity (ROP) is a condition affecting the underdeveloped retinas of premature infants, particularly those exposed to oxygen therapy. While mild cases often resolve on their own, severe ROP can cause retinal detachment, vision loss, or blindness. ROP remains a challenge due to the need to balance treatment benefits and risks. Anti-Vascular Endothelial Growth Factor (VEGF) therapy has emerged as a promising, minimally invasive treatment for significant ROP, offering shorter administration time, ease of use, and reduced need for surgery or anesthesia. This treatment is increasingly initiated in NICUs following routine screening. However, uncertainties remain regarding the best Anti-VEGF drug, dosing strategies, potential systemic side effects, and long-term neurodevelopmental impacts. Under the guidance of an ophthalmologist, Anti-VEGF agents are the preferred first-line therapy in many cases, whereas laser therapy remains the gold standard for others. Neonatologists and paediatricians must be well-versed in ROP screening, risk factors, and treatment approaches to ensure optimal outcomes for preterm infants.
