Intravitreal bevacizumab as single drug therapy for retinopathy of prematurity in 12 patients

doi:10.5546/aap.2014.eng.160

Cited by 1 publication

(1 citation statement)

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“…This way they can prevent further progression of the disease and induce regression of new vessels, showing an acceptable safety profile at 24 weeks after the beginning of treatment ( 33 ). The most commonly anti-VEGF agent used in preterm infants is bevacizumab and it has great evidence of successful outcomes for the treatment of threshold ROP either as a single treatment or as an adjuvant to standard laser therapy ( 66 , 67 , 72 ). Indeed, they showed similar effectiveness of laser photocoagulation but with a significantly lower percentage of later refractive alterations ( 73 , 74 ).…”

Section: Preventive or Therapeutic Strategiesmentioning

confidence: 99%

Propranolol: a new pharmacologic approach to counter retinopathy of prematurity progression

Pascarella,

Scaramuzzo,

Pini

et al. 2024

Front. Pediatr.

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Despite the evident progress in neonatal medicine, retinopathy of prematurity (ROP) remains a serious threat to the vision of premature infants, due to a still partial understanding of the mechanisms underlying the development of this disease and the lack of drugs capable of arresting its progression. Although ROP is a multifactorial disease, retinal vascularization is strictly dependent on oxygen concentration. The exposition of the retina of a preterm newborn, still incompletely vascularized, to an atmosphere relatively hyperoxic, as the extrauterine environment, induces the downregulation of proangiogenic factors and therefore the interruption of vascularization (first ischemic phase of ROP). However, over the following weeks, the growing metabolic requirement of this ischemic retina produces a progressive hypoxia that specularly promotes the surge of proangiogenic factors, finally leading to proliferative retinopathy (second proliferative phase of ROP). The demonstration that the noradrenergic system is actively involved in the coupling between hypoxia and the induction of vasculogenesis paved the way for a pharmacologic intervention aimed at counteracting the interaction of noradrenaline with specific receptors and consequently the progression of ROP. A similar trend has been observed in infantile hemangiomas, the most common vascular lesion of childhood induced by pre-existing hypoxia, which shares similar characteristics with ROP. The fact that propranolol, an unselective antagonist of β1/2 adrenoceptors, counteracts the growth of infantile hemangiomas, suggested the idea of testing the efficacy of propranolol in infants with ROP. From preclinical studies, ongoing clinical trials demonstrated that topical administration of propranolol likely represents the optimal approach to reconcile its efficacy and maximum safety. Given the strict relationship between vessels and neurons, recovering retinal vascularization with propranolol may add further efficacy to prevent retinal dysfunction. In conclusion, the strategy of contrasting precociously the progression of the disease appears to be more advantageous than the current wait-and-see therapeutic approach, which instead is mainly focused on avoiding retinal detachment.

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