Anti-vascular Endothelial Growth Factor Treatment of Retinopathy of Prematurity: Efficacy, Safety, and Anatomical Outcomes

Abstract

PurposeTo investigate the efficacy, safety, and anatomical outcomes associated with intravitreal anti-vascular endothelial growth factor (VEGF) treatment of retinopathy of prematurity (ROP).MethodsWe performed a retrospective review of intravitreal anti-VEGF (bevacizumab or ranibizumab) treatment of 153 eyes (83 infants) diagnosed with ROP at two tertiary hospitals from June 2011 to January 2017. The primary outcome was the rate of recurrence requiring additional treatment; secondary outcomes included incidence of major complications and final refractive error.ResultsA total of 101 eyes were treated with bevacizumab, and 52 with ranibizumab. The bevacizumab and ranibizumab groups were characterized by mean birthweights of 941.8 ± 296.1 and 1,257.7 ± 514.5 g, gestational ages at birth of 26.9 ± 1.9 and 28.1 ± 3.2 weeks, and postmenstrual ages at treatment of 40.4 ± 2.4 and 39.2 ± 2.3 weeks, respectively. The two groups differed significantly in birthweights and gestational ages at birth, but not in postmenstrual ages at treatment. The mean follow-up duration was 30.9 ± 18.4 months for the bevacizumab group, and 13.9 ± 12.5 months for ranibizumab. More cases were classified as zone 1 ROP in the ranibizumab group (44.2% vs. 11.9%, p < 0.001). Major surgical interventions included scleral encircling and vitrectomy (one and two eyes, respectively, both in the bevacizumab group). Retinal detachment was noted in one eye treated with bevacizumab. There was no significant difference in the most recent spherical equivalence for the two groups (+0.10 ± 3.66 and +0.22 ± 3.00 diopters for bevacizumab and ranibizumab, respectively). Univariable analysis revealed that only ROP stage influenced the occurrence of major complications (odds ratio, 9.046; p = 0.012).ConclusionsIntravitreal anti-VEGF treatment of ROP with both bevacizumab and ranibizumab achieved stable retinal vascularization with a low rate of complications and recurrence. Ranibizumab achieved similar anatomical outcomes as bevacizumab, without additional risk for major complications.

Evaluation of Infants with Retinopathy of Prematurity Treated with Intravitreal Bevacizumab

“…Although uncommon, some complications such as cataract, vitreous hemorrhage, corneal abrasion/opacity, endophthalmitis, hyphema, and thromboembolic events may develop after bevacizumab injection (29). As in our study, there are publications reporting no complications after IVI (30,31).…”

Ursodeoxycholic Acid Halts Pathological Neovascularization in a Mouse Model of Oxygen-Induced Retinopathy

“…The therapeutic treatment of ROP is particularly challenged by the use of invasive anti-RNV therapies often resulting in the blockade of normal postnatal retinal vasculogenesis and damage to the neuroretina [53]. The results of our studies demonstrate that UDCA can halt pathological neovascularization in the ischemic postnatal retina without affecting normal vascular growth or provoking systemic toxicity ( Figure S2), thus satisfying two very important characteristics of a drug candidate for the treatment of ROP.…”

Refractive outcomes after intravitreal injection of antivascular endothelial growth factor versus laser photocoagulation for retinopathy of prematurity: a meta-analysis

“…[7][8][9] However, the effects of this intervention are relatively short term, while its long-term complications remain unclear, such as postoperative refractive errors. Kang et al 10 showed that anti-VEGF drugs do not cause refractive errors after ROP treatment, while Kabataş et al 11 found that effects of the intravitreal injection of anti-VEGF drugs did not differ significantly from those of laser photocoagulation, with both potentially causing refractive errors.…”