Advances in understanding and management of retinopathy of prematurity

Abstract

The understanding, diagnosis and treatment of retinopathy of prematurity (ROP) have changed in the last seventy years since the original description of retrolental fibroplasia associated with high oxygenation. It is now recognized that ROP differs in appearance world-wide and as ever smaller and younger premature infants survive. New methods are being evaluated to image the retina, diagnose severe ROP, and determine windows of time for treatment to save eyes and improve visual and neural outcomes. New treatments to promote physiologic retinal vascular development, vascular repair, and inhibit vasoproliferation by regulating proteins involved in vascular endothelial growth factor, insulin-like growth factor, or erythropoietin signaling. Reducing excessive oxidative/nitrosative stress and understanding progenitor cells and neurovascular and glial vascular interactions are being studied.

Targeted Knockdown of Overexpressed VEGFA or VEGF164 in Müller cells maintains retinal function by triggering different signaling mechanisms

“…Excessive VEGF signaling disorders developmental angiogenesis in the preterm infant retina and contributes to severe, vision-threatening ROP 3 . However, VEGF is also important in retinal 6 , 17 , 21 and other organ development 8 .…”

“…When the infant is moved from supplemental oxygen to room air, poor oxygenation of the avascular retina stimulates disordered growth of retinal blood vessels into the vitreous rather than into the avascular retina. This intravitreal neovascularization can develop into severe, vision-threatening ROP 3 . Treatment of severe ROP is evolving with the use of anti-angiogenic agents that inhibit the bioactivity of vascular endothelial growth factor (VEGF) instead of standard care laser photocoagulation of the peripheral avascular retina 4 .…”

Blockade of TREM-1 prevents vitreoretinal neovascularization in mice with oxygen-induced retinopathy

“…In addition, vitreoretinal neovascularization can promote traction retinal detachment, leading to blindness [5]. In the United States, 14,000–16,000 premature infants are affected by ROP annually [6,7]. Conventional therapeutic options include laser ablation and the anti-vascular endothelial growth factor (VEGF) therapy, which both have their limitations and complications.…”

The utility of ultra-widefield fluorescein angiography in pediatric retinal diseases

“…Type I ROP is treated with laser photocoagulation or intravitreal anti-VEGF agents. In the past, fluorescein angiography was not standard care for ROP [ 23 , 24 ]. However, with the advent of agents that inhibit the bioactivity of vascular endothelial growth factor (VEGF) and studies that test efficacy and safety of dose, it has been realized that anti-VEGF agents can change the natural history of ROP and that intravitreal neovascularization and later tractional retinal detachments occur even a year after an injection [ 25 ].…”