A Systematic Review and Meta-Analysis on the Safety of Vascular Endothelial Growth Factor (VEGF) Inhibitors for the Treatment of Retinopathy of Prematurity

Abstract

IntroductionLaser photocoagulation is the current gold standard treatment for proliferative retinopathy of prematurity (ROP). However, it permanently reduces the visual field and might induce myopia. Vascular endothelial growth factor (VEGF) inhibitors for the treatment of ROP may enable continuing vascularization of the retina, potentially allowing the preservation of the visual field. However, for their use in infants concern remains. This meta-analysis explores the safety of VEGF inhibitors.MethodsThe Ovid Interface was used to perform a systematic review of the literature in the databases PubMed, EMBASE and the Cochrane Library.ResultsThis meta-analysis included 24 original reports (including 1.457 eyes) on VEGF inhibitor treatment for ROP. The trials were solely observational except for one randomized and two case-control studies. We estimated a 6-month risk of retreatment per eye of 2.8%, and a 6-month risk of ocular complication without the need of retreatment of 1.6% per eye. Systemic complications were only reported as isolated incidents.DiscussionVEGF inhibitors seem to be associated with low recurrence rates and ocular complication rates. They may have the benefit of potentially allowing the preservation of visual field and lower rates of myopia. Due to the lack of data, the risk of systemic side effects cannot be assessed.

Review of the mechanisms and therapeutic avenues for retinal and choroidal vascular dysfunctions in retinopathy of prematurity

“…Several clinical studies have documented the use of anti‐VEGF therapy to tackle the neovascular phase of ROP . A generally favourable outcome was detected in the majority of the reports, but in some of the studies, adverse effects, such as endophthalmitis, haemorrhage, retinal detachment and cataract, were also reported .…”

“…A generally favourable outcome was detected in the majority of the reports, but in some of the studies, adverse effects, such as endophthalmitis, haemorrhage, retinal detachment and cataract, were also reported . The main advantages of anti‐VEGF therapy over the use of laser include the following: easier administration under topical anaesthesia and preservation of visual field and lower rates of myopia . However, a number of disadvantages have emerged during its use in clinical or animals models.…”

Heme relieves the inhibition of proliferation, migration and angiogenesis of HMEC-1 under hyperoxia by inhibiting BACH1

“…Fundus laser photocoagulation and intravitreal injection of anti VEGF drugs were the main therapies, but both have certain side effects: Fundus laser treatment can cause certain damage to retina and irreversible damage to children's peripheral vision. Intravitreal injection of anti VEGF drugs may lead to endophthalmitis and traumatic cataract, when anti VEGF drugs enter the blood circulation, it will affect the development of blood vessels in other organs, especially the brain, lung and kidney [3,24]. Moreover, these two therapies are not effective in all ROP cases, and the search for therapeutic drugs for phase I ROP has become a hot spot in recent years.…”

Antivascular endothelial growth factor in the treatment of retinopathy of prematurity

“…Most systemic complications were thought to be incidental and not caused by anti-VEGF injection. Overall, the meta-analysis concluded that anti-VEGF therapy has a low-risk profile in ROP treatment in the first 6 months [25].…”