Cryotherapy for active retinopathy of prematurity

Tasman, William; Brown, Gary C.; Naidoff, Michael A.; Schaffer, David B.; Benson, William E.; Quinn, Graham E.; Diamond, Gary R.

doi:10.1007/bf02155794

Cited by 10 publications

(6 citation statements)

References 2 publications

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“…2 Despite various treatment modalities that include panretinal photocoagulation, cryotherapy, and vitrectomy, progressive retinal NV continues to occur with subsequent severe visual loss. 6,7,8,9 Moreover, age-related macular degeneration (AMD) is the most common cause of severe visual loss in people over the age of 65; 10 and the wet or exudative form is characterized by choroidal NV. 11 Recent studies indicate that a link exists between vascular endothelial growth factor (VEGF) and various ocular diseases and that VEGF may be an essential part of the molecular signaling cascade leading to retinal NV.…”

Section: Introductionmentioning

confidence: 99%

Intravitreal VEGF and bFGF produce florid retinal neovascularization and hemorrhage in the rabbit

Wong

Rich²,

Liaw³

et al. 2001

Current Eye Research

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Purpose. Vascular endothelial growth factor (VEGF) causes widespread retinal vascular dilation, produces breakdown of the blood-retinal barrier, and is implicated in ocular neovascularization (NV). Basic fibroblast growth factor (bFGF) also has been implicated in the production of ocular NV. This study was performed to investigate the ability of simultaneous sustained intravitreal release of both VEGF and bFGF to induce robust retinal NV in the rabbit.Methods. Intravitreal implantation of sustained-release Hydron polymeric pellets containing both 20 mg of VEGF and 20 mg of bFGF was performed on adult male Dutch belted rabbits. In other animals either 20 mg or 50 mg bFGFcontaining pellets was implanted intravitreally; also, either 20 mg VEGF or 50 mg VEGF-containing pellets was implanted. Control rabbits received either blank polymeric pellets or a pellet containing 30 mg bovine serum albumin. Eyes were examined by indirect ophthalmoscopy after surgery at 24 hrs, 48 hrs, 4 days, 7 days, 14 days, 21 days, and 28 days. Findings were documented by color fundus photography and fluorescein angiography (FA). Eyes were enucleated and prepared for histologic analysis at 28 days following intravitreal implantation of the VEGF/bFGFcontaining pellets.Results. In all eyes implanted with VEGF/bFGF pellets, dilation and tortuosity of existing blood vessels were observed within 48 hrs after pellet implantation. The progression of retinal vascular changes was rapid and occurred over the entire optic disk and medullary rays between 4 and 7 days. Hemorrhage occurred as early as 14 days after VEGF/bFGF pellet implantation. In eyes with massive hemorrhage, total traction retinal detachment developed after the second week.The presence of abnormal tissues at the vitreo-retinal interface within 28 days was demonstrated by light microscopy while FA showed profuse leakage of dye from anomalous vessels within the first week. Neither bFGF-exposed eyes nor control eyes showed any vascular changes. Eyes that received only VEGF-containing pellets exhibited tortuosity of existing vessels, but neither hemorrhaging nor retinal detachment occurred.Conclusions. These results demonstrate that retinal vascular changes leading to hemorrhaging is produced rapidly in the rabbit by simultaneous intravitreal release of both VEGF and bFGF. Understanding how these growth factors induce retinal NV may suggest novel therapeutic treatment strategies.

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Section: Introductionmentioning

confidence: 99%

Intravitreal VEGF and bFGF produce florid retinal neovascularization and hemorrhage in the rabbit

Wong

Rich²,

Liaw³

et al. 2001

Current Eye Research

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“…This decision had been made before our pilot work in cryotherapy for severe disease [10] and allowed the child with the most severe forms of ROP the only treatment felt reasonable at the time. To the extent that antioxidant treatment was effective in already established ROP, we expected that such treatment would diminish any observable differences between E and P treatment group assignment.…”

Section: Discussionmentioning

confidence: 98%

Incidence, severity and time course of ROP in a randomized clinical trial of vitamin E prophylaxis

et al. 1990

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We report the effect of prophylactic administration of an antioxidant on the incidence and severity of both the acute and chronic phases of ROP, as well as the influence of E on the time course of the disease. These data were collected during a double-masked clinical trial of the use of vitamin E at 5 mg/dl as prophylaxis for retinopathy ofprematurity (ROP) and its residua.Our group had earlier reported two smaller clinical trials [1,2] in which the antioxidant had been started during the first day after birth and was administered during the period of retinal vascularization at lower, more physiologic levels of 1.5 to 2.5 mg/dl which showed a decreased incidence and severity of ROP. Another protocol from 1976-78 suggested a possible benefit from higher levels of E at the diagnosis of severe ROP [2] as the visual outcome of these infants was better than expected from the literature [3]. This work led to the present trial which employed intravenous, as well as intramuscular and later oral, routes of the active form of the vitamin (free dl alpha tocopherol) to achieve a target serum level of 5 mg/dl from as soon as possible after birth on. Our goals were to: 1) assess the effect of E on both incidence and severity of ROP, 2) assess the possible effect of starting E at the diagnosis of severe disease, defined as Grade 3 + ROP with extraretinal neovascularization in more than 2 quadrants [4], 3) observe the natural history of ROP and its residua in study infants with long term follow up

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“…The clinical use of trans-scleral cryotherapy for ROP was pioneered in 1972 by Japanese investigators [40]. Subsequently, other reports on small series of patients treated with cryotherapy demonstrated a more favourable outcome in the treated group [14,35]. Now the results of a multicentre trial of cryotherapy for ROP (CRYO-ROP study) that started in 1986 are available [6,7].…”

Section: Surgical Proceduresmentioning

confidence: 98%

“…Since the earliest descriptions of retinopathy of prematurity (ROP) by Terry [35] who named it retrolental fibroplasia, therapy has remained unsatisfactory and controversial, It is the object of this article to summarise current modalities of diagnosis and treatment. The overall incidence of children with some signs of acute ROP is in the order of 16%-17% according to studies by Tasman [33], Zak [41] and Kalina [19].…”

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confidence: 99%

Retinopathy of prematurity-current diagnosis and management

Göbel¹,

Richard²

1993

Eur J Pediatr

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Despite advances in ophthalmological care of premature infants, retinopathy of prematurity (ROP) remains a still unsolved problem for paediatricians as well as ophthalmologists. A survey of the current literature concerning drug therapy and surgical management as related to the different stages of ROP is given. The classification system for ROP according to the International Committee is presented as well as our screening policy in relation to the literature. The effectiveness in preventing severe cases of ROP and the toxicity of vitamin E supplementation in high-risk premature infants is still disputed and no recommendations can be given. Cryotherapy is recommended in symmetric cases of stage 3 + ROP. Nevertheless, quite a number of eyes still progress to more severe stages of ROP. Scleral buckling procedures and vitrectomy may lead to anatomical success in a few cases of retinal detachment, however, the visual outcome of such an operation is usually very poor despite reattachment of the central retina.

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Cryotherapy for active retinopathy of prematurity

Cited by 10 publications

References 2 publications

Intravitreal VEGF and bFGF produce florid retinal neovascularization and hemorrhage in the rabbit

Intravitreal VEGF and bFGF produce florid retinal neovascularization and hemorrhage in the rabbit

Incidence, severity and time course of ROP in a randomized clinical trial of vitamin E prophylaxis

Retinopathy of prematurity-current diagnosis and management

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