Laser versus Anti-VEGF: A Paradigm Shift for Treatment-Warranted Retinopathy of Prematurity

Abstract

Retinopathy of prematurity (ROP), a leading cause of childhood blindness, has historically been associated with blindness from overgrowth of blood vessels from the retina into the vitreous that lead to complex retinal detachments. Our understanding of ROP has evolved with the survival of extremely low-birthweight infants and includes not only overgrowth of blood vessels, but also insufficient developmental retinal vascular growth in early phases of the disease. Our current treatments of ROP have focused on methods to improve perinatal and prenatal care, reduce premature birth, and prevent early phases of ROP. Nonetheless, addressing vasoproliferation in treatment-warranted eyes remains the mainstay of management. Two main treatment strategies co-exist today: laser treatment, which has been the standard of care since the 1990s, and anti-VEGF injections, which have been used since early reports in 2007 (Travassos et al. in Ophthalmic Surg Lasers Imaging, 38:233–237, 10.3928/15428877-20070501-09, 2007, Shah et al. in Indian J Ophthalmol 55:75–76, 10.4103/0301-4738.29505, 2007, Quiroz-Mercado et al. in Semin Ophthalmol 22:109–125, 10.1080/08820530701420082, 2007).

Editorial: Identification of novel biomarkers for retinopathy of prematurity in preterm infants by use of innovative technologies and artificial intelligence

“…Advances in our understanding of retinopathy of prematurity (ROP) have improved its management and outcomes (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). However, additional research is needed, including our ability to predict those infants at greatest risk of blindness.…”

“…Several studies have pioneered ROP biomarker research in the blood of preterm infants. Many have focused on the role that vascular endothelial growth factor (VEGF) and insulinlike growth factor (IGF-1) play in neovascular development in the neonatal retina (5,11,(21)(22)(23)(24)(25)(26)(27)(28). More recently, advancements have been made in high-throughput omics techniques that allow the exploration of molecular profiles of metabolites, proteins, lipids, gene variants, and micro-RNA.…”

Characteristics of retinal vascularization in reactivated retinopathy of prematurity requiring treatment and clinical outcome after reinjection of ranibizumab

“…The BEAT-ROP study 5 and the RAINBOW study 6 demonstrated the effectiveness of intravitreal injection of anti-VEGF agents in treating ROP. Recent years have witnessed a paradigm shift in the treatment of ROP from laser treatment to anti-VEGF injection 7 . Anti-VEGF injection offers several advantages over laser treatment such as eliminating the need for general anesthesia, providing a rapid clinical response, and permitting vascularization into the immature retina without causing permanent retinal damage 8 .…”