scholarly journals Treatment outcomes of central retinopathy of prematurity with localization in the Moscow regional perinatal center

2021 ◽  
Vol 16 (3) ◽  
pp. 19-26
Author(s):  
A. Y. Panova ◽  
A. S. Petrova ◽  
S. A. Trusova ◽  
O. A. Shevernaya
Keyword(s):  
Laser Treatment ◽  
Retinopathy Of Prematurity ◽  
Promising Result ◽  
Antiangiogenic Therapy ◽  
Combined Treatment ◽  
Posterior Pole ◽  
Laser Coagulation ◽  
Vegf Inhibitor ◽  
Anti Vegf ◽  
Perinatal Center

BACKGROUND: Ranibizumab is widely used in retinopathy of prematurity. Therefore, it is necessary to evaluate the effectiveness, the risk of complications, and recurrence of the disease by antiangiogenic therapy. AIM: To demonstrate the experience of using anti-VEGF drugs in the Moscow Regional Perinatal Center and the effectiveness of different approaches to retinopathy of prematurity (ROP) treatment in the central retinal zone. MATERIAL AND METHODS: The case histories of 17 deeply premature infants with threshold ROP stages and localization in the posterior pole were retrospectively analyzed. Children were treated with intravitreal VEGF inhibitor (total 9 children), 5 children underwent laser coagulation of the retina, and 3 children received combined treatment (laser and intravitreal administration of a VEGF inhibitor). RESULTS: The average age of development of threshold stages was 35.2 weeks (range: 30.539 weeks) in our study. The frequency of promising outcomes after using anti-VEGF drugs alone or in conjunction with peripheral laser treatment was 100%. In comparison, the only laser treatment generated a promising result in 70% of the eyes. However, ROP relapses after anti-VEGF therapy developed at 37, 43, 44,5 weeks. In addition, 1 out of 9 children developed a recurrence of ROP and required laser treatment 7 weeks after using anti-VEGF. CONCLUSION: The use of anti-VEGF therapy is an effective method for the treatment of ROP of the posterior pole. However, there is the ambiguity of the available recommendations on the further management of children. Therefore, it is necessary to monitor the children who have received antiangiogenic therapy for as long as possible.

scholarly journals New opportunities in management of patients with retinopathy prematurity (literature review and analysis of own data)

2020 ◽  
Vol 13 (4) ◽  
pp. 70-74
Author(s):  
L. A. Katargina ◽  
E. N. Demchenko
Keyword(s):  
Retinopathy Of Prematurity ◽  
Randomized Study ◽  
Clinical Effectiveness ◽  
Posterior Pole ◽  
Peripheral Retina ◽  
Laser Coagulation ◽  
Type I ◽  
Degree Relative ◽  
Anti Vegf ◽  
Increased Risk

Insufficient effectiveness of laser coagulation of the avascular retinal areas in retinopathy of prematurity (ROP) plus-disease in zone I and aggressive posterior retinopathy of prematurity (APROP) requires new treatment approaches, based on the regulation of retinal angiogenesis and anti-VEGF drugs use. The BEAT-RAP study, which was the first major randomized study of anti-VEGF therapy in ROP, revealed a higher effectiveness of bevacizumab compared to retinal laser coagulation in stage 3 plus-disease of zone I. A prospective randomized trial, RAINBOW, demonstrated the effectiveness of ranibizumab in plus-disease stages 1, 2 and 3 in zone I and stage 3 in zone II and in APROP, so that the drug may be recommended for use in children with ROP. The demonstrated high effect of anti-VEGF therapy in ROP is consistent with our own data. Anti-VEGF therapy opens up new possibilities in the treatment of a particular class of ROP forms. The advantages of anti-VEGF therapy include higher clinical effectiveness of treatment of ROP type I with localization in the posterior pole (I and posterior II zone), absence of "blockage" of the peripheral retina, lower frequency of myopia development and degree, relative fastness of the procedure, the acceptability for patients whose fundus is difficult to visualize, and somatically burdened patients who are contraindicated for prolonged anesthesia used for retinal laser coagulation. When using anti-VEGF drugs in the post-threshold stages of the disease, one should take account of an increased risk of proliferation progression and retinal detachment development. Premature infants with retinopathy regression after anti-VEGF therapy require a longer duration of regular and frequent follow-up (up to 70 weeks of postmenstrual age) due to the risk of relapse and extraretinal proliferation in future.

scholarly journals Angiographic Findings in Cases with a History of Severe Retinopathy of Prematurity Treated with anti-VEGFs Follow-up to Age 6 Years

2021 ◽  
Author(s):  
Hande Celiker ◽  
Ozlem Sahin
Keyword(s):  
Laser Treatment ◽  
Retinopathy Of Prematurity ◽  
Posterior Pole ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
History Of ◽  
Endothelial Growth Factor ◽  
Developmental Features

Abstract Purpose: To report the effects of anti-vascular endothelial growth factor (VEGF) treatment in vascular development for cases of acute retinopathy of prematurity (ROP) using fluorescent angiography (FA) and to present the results of our observational approach to retinal sequelae.Methods: A total of 31 eyes in 19 patients with a history of treatment with anti-VEGF agents for classic type 1 ROP and aggressive posterior ROP who underwent FA between March 2014 to February 2020 were reviewed. Angiograms of retinal developmental features of patients aged 4 months to 6 years were examined. Results: The patients mean gestational age were 26.06±1.90 weeks and the mean birth weight were 837.68±236.79g. All cases showed various abnormalities at the vascular and avascular retina, and the posterior pole. All but one case showed a peripheral avascular area on FA evaluation during the follow-up period. We did not apply prophylactic laser treatment to these avascular retina. On the final examination, except one case, we did not observe any late reactivation in any patients. Conclusion: FA is an important tool for assessing vascular maturation in infants. Every leakage should not be assumed to be evidence of late activation, as some leaks may be related to vascular immaturity. Retinal vascularization may not be completed in all patients, however this does not mean that all these patients need prophylactic laser application. Our observational approach may be more daring than the reports frequently encountered in the literature, but it should be noted that unnecessary laser treatment will also eliminate all the advantages of anti-VEGF treatment.

The first experience of application of vessel endothelium growth factor inhibitor ranibizumab in complex therapy of retinopathy of premature in URFO in SAHI of the Sverdlovsk region MСMC «Bonum»

2021 ◽  
pp. 360-362
Author(s):  
M.A. Kariakin ◽  
◽  
E.A. Stepanova ◽  
S.A. Korotkikh ◽  
N.S. Timofeeva ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Intravitreal Injection ◽  
Laser Treatment ◽  
Retinopathy Of Prematurity ◽  
Laser Coagulation ◽  
Complete Regression ◽  
Complex Treatment ◽  
Partial Regression ◽  
Factor Inhibitor ◽  
Retinal Adhesion

Material and methods. The study included 16 patients (31 eyes). Types and terms of treatment. Stage I in the treatment of ROP, laser coagulation of the avascular areas of the retina was performed in three patients with aggressive posterior ROP (4 eyes, 12.9%). In all patients, the progression of the disease was noted. Intravitreal injection of ranibizumab was performed in the period from 8 to 16 weeks (10.5±2.0 weeks), PCV from 32.3 to 39.6 weeks (37.0±1.8 weeks). Result. After laser treatment and IVI of ranibizumab, 11 patients (31 eyes, 81.6%) showed regression of the disease. In 5 patients (6 eyes, 19.4%) - progression. If the ROP progressed, a 25G or 27G lenssparing vitrectomy was performed. Complete regression of ROP was achieved in one patient (1 eye, 16.7%). Partial regression was observed in two patients (2 eyes, 33.3%). In two patients (3 eyes, 50%), the disease progressed to stage 5 with the development of total retinal detachment. Conclusion. As a result of the complex treatment of severe forms of the active stage of retinopathy of prematurity in the regional children's ophthalmological center MKMC "Bonum" in Yekaterinburg, the following data were obtained: complete regression with retinal adhesion is observed in 12 patients (26 eyes, 83.4%), of which in one patient (1 eye, 3.2%) regression was achieved after vitrectomy. Partial regression with the formation of a peripheral retinal detachment after vitrectomy was achieved in two patients (two eyes - 6.5%). Progression of retinopathy of prematurity to stage V with the development of total retinal detachment in two patients (3 eyes, 9.6%). Complex treatment of severe stages of active ROP using laser treatment, IVI and vitrectomy allows to preserve vision in 90.4% of patients. Key words: retinopathy of prematurity; intravitreal injection; laser coagulation of the retina; vitrectomy.

Сombined (anti-VEGF and laser) treatment for operated secondary refractory neovascular glaucoma

2021 ◽  
pp. 24-26
Author(s):  
A.A. Gamidov ◽  
◽  
Z.V. Surnina ◽  
I.V. Andreeva ◽  
I.A. Velieva ◽  
...  
Keyword(s):  
Laser Treatment ◽  
Antihypertensive Drugs ◽  
Optimal Algorithm ◽  
Sequential Therapy ◽  
Neovascular Glaucoma ◽  
Hypotensive Effect ◽  
Laser Coagulation ◽  
Anti Vegf ◽  
Secondary Refractory

Purpose. To develop an optimal algorithm for the management of patients with operated neovascular uncompensated glaucoma. Material and methods. 2 patients with operated secondary neovascular glaucoma of stage III-c. In the combined sequential therapy, the anti-VEGF medication Ranibizumab (0.5 mg) was used, laser coagulation of residual newly formed vessels, laser reconstruction in the surgical area, contact transcleral cyclolazercoagulation, and laser coagulation of the peripheral parts of the retina were performed. Results. The combined sequential treatment, combined with the appointment of antihypertensive drugs in drops, allowed to stabilize the level of IOP. IOP indicators remained at the level of normal values during 1 year of follow-up. Conclusion. The use of combined laser technologies and anti-VEGF therapy makes it possible to potentiate and prolong the hypotensive effect in the treatment of patients with operated secondary refractory neovascular glaucoma. Key words: operated neovascular glaucoma, anti-VEGF, combined laser treatment.

scholarly journals Aggressive Posterior Retinopathy of Prematurity (AP-ROP)

2018 ◽  
pp. 63-68
Keyword(s):  
High Risk ◽  
Early Diagnosis ◽  
Laser Treatment ◽  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Clinical Course ◽  
Clinical Findings ◽  
Posterior Pole ◽  
Diagnosis And Treatment ◽  
Preterm Babies

Aggressive retinopathy of prematurity (AP-ROP) has subtle clinical findings that may preclude early diagnosis and treatment. Premature infants with AP-ROP have a progressive clinical course and may benefit from early laser treatment. Although subjective in nature, plus disease, and any posterior pole changes especially at the border of the vascular and avascular retina should be carefully evaluated, keeping AP-ROP in mind in especially high-risk preterm babies.

scholarly journals Clinical Course and Results of Anti-VEGF Therapy of Retinopathy of Prematurity

2021 ◽  
Vol 18 (1) ◽  
pp. 136-142
Author(s):  
L. A. Katargina ◽  
E. N. Demchenko ◽  
L. V. Kogoleva
Keyword(s):  
Retinopathy Of Prematurity ◽  
Functional Outcomes ◽  
Clinical Course ◽  
Repeated Administration ◽  
Additional Treatment ◽  
Research Centre ◽  
Peripheral Retina ◽  
Laser Coagulation ◽  
Anti Vegf

The clinical course of active retinopathy after anti-VEGF therapy, the possibility and timing of recurrence of the disease, anatomical and functional outcomes of treatment are widely discussed in the press, not fully studied and relevant.Purpose: to study the clinical course of active retinopathy of prematurity after anti-VEGF therapy and clinical and functional outcomes.Patients and Methods. Children with active retinopathy of prematurity, who turned to the Helmgoltz National Medical Research Centre of Eye Diseases after anti-VEGF therapy, examined by indirect binocular ophthalmoscopy and digital retinal camera (RetcamShuttle). Children were monitored from 1.5 to 6 years (average 2.94 ± 1.47). All children underwent routine examination, 4 children older than 3 years underwent optical coherence tomography.Results. In all cases, after anti-VEGF therapy, there was a decrease in vascular activity and continued vascularization of the retina. Recurrence of the disease requiring additional treatment, were detected in 11 (42.3 %) eyes within 6–22 weeks (in average 13.33 ± 5.57) after intravitreal anti-VEGF therapy. Laser coagulation of the retina was carried out in 4 children (7 eyes) and repeated administration of anti-VEGF drug — 2 children (4 eyes), which led to regression of the disease. In the long-term period, all 13 (100 %) children had successful outcomes.Conclusion. Anti-VEGF therapy is effective in plus-zone 1 disease and posterior aggressive retinopathy of prematurity. Its advantages include the ability to treat retinopathy in zone 1 posterior, the absence of “blockade” of the peripheral retina with the possibility of continued growth of blood vessels to the periphery, lower frequency and severity of myopia. The disadvantages include the possibility of recurrence of the disease, which requires long-term regular monitoring.

scholarly journals Intravitreal bevacizumab injection alone or combined with macular photocoagulation compared to macular photocoagulation as primary treatment of diabetic macular edema

2015 ◽  
Vol 72 (10) ◽  
pp. 876-882 ◽  
Author(s):  
Sandra Jovanovic ◽  
Vladimir Canadanovic ◽  
Ana Sabo ◽  
Zorka Grgic ◽  
Milena Mitrovic ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Laser Treatment ◽  
Diabetic Macular Edema ◽  
Combined Treatment ◽  
Intravitreal Bevacizumab ◽  
Primary Treatment ◽  
Intravitreal Bevacizumab Injection ◽  
Vegf Inhibitor ◽  
The Mean

Background/Aim. Within diabetic retinopathy (DR), diabetic macular edema (DME) is one of the leading causes of the loss of visual acuity. The aim of this study was to determine the efficacy of the intravitreal vascular endothelial growth factor (VEGF) inhibitor application alone or combined with macular focal/grid lasephotocoagulation compared with laser treatment alone. Methods. This prospective randomized clinical trial included 72 patients (120 treated eyes) with varying degrees of DR and DME. The DME treatment included intravitreal VEGF inhibitor bevacizumab (Avastin?) application, with and without laser treatment. Bevacizumab (1.25 mg/0.05 mL) was administered intravitreally in 4-6-week intervals. Laser is applied 4-6 weeks after last dose of the drug as a part of combined treatment, or as the primary treatment. Results. The mean reduction in central macular thickness (CMT) for the eyes (n = 31) treated with bevacizumab alone was 162.23 ?m, for the eyes (n = 53) treated with combined treatment the mean reduction in CMT was 124.24 ?m, both statistically significant at p < 0.001. Laser macular photocolagulation as a part of combined treatment (in 53 eyes) significantly contributed to the CMT reduction, based on the paired t-test results (366.28 vs 323.0 ?m at p < 0.05). In our study, the mean visual acuity improvement of 0.161 logMAR was achieved in the group of eyes treated with bevacizumab alone, and 0.093 logMAR in the group with combined treatment, both statistically significant at p < 0.05. The effect of laser photocolagulation alone on visual acuity and CMT was not statistically significant. Conclusion. Treatment with bevacizumab alone or within combined treatment is more effective in treating DME than conventional macular laser treatment alone, both anatomically and functionally.

Systematic review and meta-analysis of the negative outcomes of retinopathy of prematurity treated with laser photocoagulation

2018 ◽  
Vol 29 (2) ◽  
pp. 223-228 ◽  
Author(s):  
Jing Liang
Keyword(s):  
Confidence Interval ◽  
Laser Treatment ◽  
Retinopathy Of Prematurity ◽  
Odds Ratio ◽  
Laser Photocoagulation ◽  
Meta Analysis ◽  
Anterior Chamber Depth ◽  
Mean Difference ◽  
Laser Coagulation ◽  
Spherical Equivalent

Introduction: Retinopathy of prematurity is a leading cause of potentially avertable childhood blindness around the world. And laser photocoagulation is currently performed as a gold standard for retinopathy of prematurity treatment, but it may contribute to elevated myopia and decreased visual field. Therefore, the objective of this meta-analysis is to explore the negative impact of laser photocoagulation for retinopathy of prematurity in terms of anatomic outcomes and structural outcomes. Methods: Studies were retrieved through literature searches in PubMed and EMBASE from 1990 to 2017 in English. Case-control studies that reported anatomic and structural changes or significant complications after laser coagulation or cryotherapy for retinopathy of prematurity were eligible. Results: This meta-analysis included eight original studies related to laser treatment for retinopathy of prematurity at any stages. A total of 1422 infants were participated, of which 1156 documented subthreshold or threshold retinopathy of prematurity without laser treatment were selected as comparison group and the rest treated with diode or argon laser coagulation were chosen for experiment group. Taking all included studies into account, spherical equivalent (mean difference −2.53, 95% confidence interval: –5.23 to 0.18, I2 = 96%, P < 0.00001), anterior chamber depth (mean difference −0.52, 95% confidence interval: −0.76 to −0.28, I2 = 55%, P = 0.11), astigmatism (odds ratio 3.19, 95% confidence interval: 1.61 to 6.32, I2 = 0%, P = 0.54), and myopia (odds ratio 8.08, 95% confidence interval: 3.79 to 17.23, I2 = 37%, P = 0.21) were associated with laser treatment for retinopathy of prematurity. Axial length (mean difference −0.01, 95% confidence interval: –0.28 to 0.27, I2 = 0%, P = 0.62) and anisometropia (odds ratio 4.21, 95% confidence interval: 0.54 to 33.17, I2 = 1%, P = 0.31) had no statistical significance on laser coagulation for retinopathy of prematurity. Conclusion: This meta-analysis showed that spherical equivalent, anterior chamber depth, astigmatism, and myopia were associated with the negative outcomes of laser coagulation, while axial length and anisometropia had no statistical importance on the defects of laser coagulation. Therefore, patients treated with laser coagulation should follow periodic cycloplegic refraction and receive early optical correction.

scholarly journals Macular Development in Aggressive Posterior Retinopathy of Prematurity

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Hemang K. Pandya ◽  
Lisa J. Faia ◽  
Joshua Robinson ◽  
Kimberly A. Drenser
Keyword(s):  
Birth Weight ◽  
Laser Treatment ◽  
Gestational Age ◽  
Retinopathy Of Prematurity ◽  
Laser Photocoagulation ◽  
Posterior Pole ◽  
Close Proximity ◽  
Postmenstrual Age ◽  
The Mean ◽  
Anterior Posterior

Purpose. To report anatomic outcomes after early and confluent laser photocoagulation of the entire avascular retina, including areas in close proximity to the fovea, in patients with APROP. We aspire to demonstrate fundoscopic evidence of transverse growth and macular development following laser treatment in APROP.Methods. Retrospective review of 6 eyes with APROP that underwent confluent laser photocoagulation of the entire avascular retina. Photographic fundoscopic imaging was performed using the RetCam to compare outcomes after treatment.Results. Mean birth weight and gestational age were 704.8 g and 24.33 weeks, respectively. There were 2 females and 1 male. The average time to laser was 9.3 weeks after birth, with the mean postmenstrual age of 34 weeks. Two eyes had zone 1 and 4 eyes had posterior zone 2 disease. Three eyes developed 4A detachments, which were successfully treated. All 6 eyes experienced transverse growth, with expansion of the posterior pole and anterior displacement of the laser treatment.Conclusion. Confluent photocoagulation of the entire avascular retina, regardless of foveal proximity, should be the mainstay for treating APROP. Examination should be conducted within 5–10 days to examine areas previously hidden by neovascularization to ensure prudent therapy. Macular development involves both transverse and anterior-posterior growth.

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