Laser photocoagulation of avascular retina remains the standard method for the treatment of retinopathy of prematurity (RP). At the same time, the outcomes of combined multi-stage surgical interventions on the patients presenting with this condition leave much to be desired. In the present review, we have undertaken the analysis of more than 50 articles related to the use of antibodies against the vascular endothelial growth factor (Anti-VEGF) that were published during the period from 2005 to 2015; the analysis included the use of the “off-label” medications as the potentially promising method for the treatment of retinopathy of prematurity. In the overwhelming majority of the studies, the use of anti-VEGF therapy as monotherapy or in the combination with conventional laser photocoagulation has been shown to be efficient for the treatment of stage III+ of the active period of retinopathy of prematurity. One of the important advantages of monotherapy is it does not cause the irreversible destruction of the peripheral retina, in contrast to the action of laser photocoagulation. Moreover, the intravitreal administration of the inhibitors of angiogenesis does not interfere with the growth of blood vessels in the peripheral retina as demonstrated by fluorescein angiography and electroretinography. At the same time, the results of certain published investigations give evidence of the important role played by the vascular endothelial growth factor in the processes of angiogenesis, glomerulogenesis, and alveolarization during the normal lung development. In addition, it has been demonstrated that bevacizumab can migrate from the vitreous body and penetrate into the systemic circulation where it causes the reduction of the serum VEGF levels in the infants presenting with retinopathy of prematurity. In connection with this, the majority of the authors emphasize the necessity of further investigations (based on the results of monitoring the concentration of serum VEGF) for the evaluation of the safety of such medications, their potential long-term effects on other organs and systems in the course of their development as well as possible adverse reactions they are likely to induce. Some problems related to the timing and dosage of the intravitreal administration of the inhibitors of angiogenesis remain a matter of controversy.
Refractive Outcomes of 4-Year-old Children after Intravitreal Anti-vascular Endothelial Growth Factor versus Laser Photocoagulation for Retinopathy of Prematurity
