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

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.

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

Russian Ophthalmological Journal ◽

10.21516/2072-0076-2020-13-4-70-74 ◽

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.

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Lens-sparing vitrectomy for stage 4A retinopathy of prematurity in infants with aggressive-posterior ROP: Anatomic and functional results

European Journal of Ophthalmology ◽

10.1177/1120672120946938 ◽

2020 ◽

pp. 112067212094693

Author(s):

Sara Macor ◽

Silvia Pignatto ◽

Antonio Capone Jr ◽

Stefano Piermarocchi ◽

Paolo Lanzetta

Keyword(s):

Retinal Detachment ◽

Retinopathy Of Prematurity ◽

Functional Outcomes ◽

Vitreous Hemorrhage ◽

Functional Results ◽

Postmenstrual Age ◽

Refractive Correction ◽

Anatomic Success

Aim: To assess long-term anatomic and functional outcomes of early lens-sparing vitrectomy (LSV) for stage 4A retinopathy of prematurity (ROP) in infants with aggressive-posterior ROP (AP-ROP) which progressed to retinal detachment despite laser treatment. Methods: Chart review of infants who underwent early 25-gage LSV for stage 4A ROP. Outcomes were anatomic success, mean visual acuity (VA), development of postoperative complications, and refractive changes. Follow-up examinations were performed at 1, 3, 6, 12, and then every 6 months. Results: Ten eyes of seven preterm infants who underwent LSV were included. Mean follow-up was 36 ± 13.4 months and mean postmenstrual age (PMA) at last follow-up was 37 ± 13.7 months. Mean gestational age (GA) and weight at birth was 26 ± 1.4 weeks and 639 ± 180 g. Two eyes had vitreous hemorrhage 4 and 14 days after surgery, respectively. At last follow-up anatomic success was 100%, mean VA was 20/80 and eight eyes (80%) had high myopic refractive correction (mean spherical equivalent –11.25 D). Conclusion: Early LSV for stage 4A ROP with AP-ROP and progression to retinal detachment is efficacious in terms of anatomic and functional outcomes. Anatomic success is associated with visual improvement despite possible myopic refraction changes during follow-up.

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Anti-VEGF therapy in the absence of the effect of laser coagulation of the retina in children with the threshold and back aggressive retinopathy of prematurity in the active phase of the disease: clinical cases

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2019-1-410-414 ◽

2019 ◽

pp. 410-414

Author(s):

D.R. Mamulat ◽

◽

M.A. Sharokhin ◽

K.A. Belousova ◽

I.L. Plisov ◽

...

Keyword(s):

Retinopathy Of Prematurity ◽

Active Phase ◽

Laser Coagulation ◽

Anti Vegf ◽

Clinical Cases

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The treatment of retinopathy of prematurity with anti-VEGF therapy in preterm infants with the progression of the disease on the background of previously performed laser coagulation of the avascular areas of the retina

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2019-4-185-187 ◽

2019 ◽

pp. 185-187

Author(s):

A.O. Nazarenko ◽

◽

E.E. Sidorenko ◽

E.I. Sidorenko ◽

◽

...

Keyword(s):

Preterm Infants ◽

Retinopathy Of Prematurity ◽

Laser Coagulation ◽

Anti Vegf

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

Russian Pediatric Ophthalmology ◽

10.17816/rpoj70957 ◽

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.

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Long-term outcomes of ophthalmosurgery in diabetic patients

Diabetes Mellitus ◽

10.14341/2072-0351-6252 ◽

2011 ◽

Vol 14 (1) ◽

pp. 69-73

Author(s):

Dmitriy Valentinovich Lipatov ◽

Elena Grigor'evna Bessmertnaya ◽

Anatoliy Gennad'evich Kuzmin ◽

Nataliya Borisovna Smirnova ◽

Anna Anatol'evna Tolkacheva ◽

...

Keyword(s):

Functional Results ◽

Neovascular Glaucoma ◽

Late Results ◽

Research Centre ◽

Laser Coagulation ◽

Diabetic Patients ◽

Diabetic Cataract ◽

Complicated Cataract ◽

Correct Application

Diabetes morbidity grows steadily despite recent progress in its diagnostics and treatment. Its most frequent complication is retinopathy although thereare increasingly more cases of diabetic cataract, secondary rubeous (neovascular) glaucoma, eyelid diseases, and transient impairment of vision.Aim To analyse late results of ophthalmosurgery in diabetic patients with vision problems.Materials and methods Over 24,000 patients were examined from January 2006 to November 2010 at the Department of Diabetic Retinopathyand Ophthalmosurgery, Endocrinological Research Centre. Results of more than 2660 seances of retinal laser coagulation and about 350 surgicalinterventions for diabetic cataract and secondary neovascular glaucoma were available for analysis.Conclusion Timely and correct application of retinal laser coagulation, modern facoemulsification of complicated cataract and drainage surgeryof uncompensated secondary rubeous glaucoma produces good functional results and permits to preserve or even improve visual acuity. The efficacyof surgical intervention is directly related to the quality of diabetes compensation and depends on the joint efforts of ophthalmologists, endocrinologists,and anesthesiologists.

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Anti-VEGF therapy of retinopathy of prematurity

Russian Pediatric Ophthalmology ◽

10.18821/1993-1859-2016-11-4-212-220 ◽

2016 ◽

Vol 11 (4) ◽

pp. 212-220

Author(s):

Nataliya Nikolaevna Sadovnikova ◽

N. V Prisich ◽

V. V Brzhesky

Keyword(s):

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Retinopathy Of Prematurity ◽

Laser Photocoagulation ◽

Vitreous Body ◽

Normal Lung ◽

Peripheral Retina ◽

Vascular Endothelial ◽

Anti Vegf ◽

Endothelial Growth Factor

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.

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Aggressive Posterior Retinopathy of Prematurity (APROP): LASER as the Primary Modality of Treatment

Journal of Ophthalmic and Vision Research ◽

10.18502/jovr.v16i3.9437 ◽

2021 ◽

Author(s):

Shilpi H Narnaware ◽

Prashant K Bawankule ◽

Dhananjay Raje

Keyword(s):

Success Rate ◽

Retinopathy Of Prematurity ◽

Case Series ◽

Additional Treatment ◽

The Other ◽

Complete Regression ◽

Anti Vegf ◽

Postmenstrual Age ◽

Prospective Case Series ◽

Primary Modality

Purpose: To study the success rate of LASER as a primary modality of treatment in aggressive posterior retinopathy of prematurity (APROP) cases. Methods: This is a prospective case series of 56 eyes of 28 preterm babies (males = 21) with APROP who underwent laser therapy. Babies were divided into groups on the basis of gestational age (GA), birth weight (BW), and postmenstrual age (PMA) at which treatment was performed. GA (in weeks): <28 (n = 7), 28–30 (n = 11), >30 (n = 10). BW (in grams): <1000 (n = 8), 1000–1200 (n = 10), >1200 (n = 10). PMA (in weeks): < 32 (n = 6), 32–34 (n = 18), >34 (n = 4). Success was calculated as complete regression of disease without need for any other modality of treatment such as anti-vascular endothelial growth factor (anti-VEGF) or pars plana vitrectomy. Results: The overall success rate was 94.64% (53/56). Two babies who needed additional modality of treatment were <28 weeks of GA (one eye) and 28–30 weeks (two eyes). One baby (one eye) was <1000 gm and the other (two eyes) was >1200 gm, while PMA at which additional treatment was needed was 30 weeks in one baby (one eye) and 33 weeks in the other (two eyes). Conclusion: In this era of anti-VEGF treatment, even in cases of APROP, LASER should still be considered as a primary modality of treatment, as it is a one-time treatment without the concern of systemic side effects and recurrent/persistent avascular zones.

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