Long-term retinal vasculature abnormalities following intravitreal bevacizumab for retinopathy of prematurity

Sternfeld, Amir; Rahmani, Safa; Rossen, Jennifer; Zhang, David L.; Li, Yuping D.; Quan, Victor L.; Huang, Russell; Yoon, Hawke

doi:10.1007/s00417-021-05499-0

Cited by 8 publications

(3 citation statements)

References 21 publications

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“…Specifically, studies have found that after treatment, FA shows vascular extension more temporally than nasally, a continuous circumferential line of demarcation separating the vascular and avascular retina, arteriovenous shunting, tortuosity without dilatation, vascular dilation, leakage, vascular loops, nonhomogeneous capillary dropout through the vascular retina including in the posterior pole, abnormal branching at the capillary level and diffuse flat neovascularization (Al Rasheed et al., 2022; Azad et al., 2008; Bayramoglu & Sayın, 2022; Cheng et al., 2019; Henaine‐Berra et al., 2014; Jin et al., 2019; Lepore et al., 2014, 2021; Mansukhani et al., 2019; Ng et al., 2006; Perente et al., 2019; Vural et al., 2022; Vural, Ekinci, et al., 2019; Vural, Perente, et al., 2019; Yokoi et al., 2009). Several studies have also found that these vascular abnormalities may prevail long after treatment with long‐term progression of the vascularization process (Al Rasheed et al., 2022; Perente et al., 2019; Sternfeld et al., 2022), although they may be reduced with photocoagulation (Gonzalez & Agarwal‐Sinha, 2020). In addition, FA may be beneficial in guiding laser treatment for aggressive ROP.…”

Section: Resultsmentioning

confidence: 99%

Vascular imaging findings in retinopathy of prematurity

Rowe,

Belamkar,

Antman

et al. 2023

Acta Ophthalmologica

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Retinopathy of prematurity (ROP) is a vascular disease among preterm infants involving incomplete or abnormal retinal vascularization and is a leading cause of preventable blindness globally. Measurements of ocular blood flow originating from a variety of imaging modalities, including colour Doppler imaging (CDI), fluorescein angiography (FA) and ocular coherence tomography angiography (OCTA), have been associated with changes in ROP patients. Herein, we discuss and summarize the relevant current literature on vascular imaging and ROP reviewed through December 2022. Differences in vascular imaging parameters between ROP patients and healthy controls are reviewed and summarized. The available data identify significantly increased peak systolic velocity (PSV) in the central retinal artery and ophthalmic artery as measured by CDI, increased vascular tortuosity as measured by FA, smaller foveal avascular zone (FAZ) as measured by FA and OCTA, and increased foveal vessel density (VD) and reduced parafoveal VD as measured by OCTA in ROP patients compared with controls. None of the above findings appear to reliably correlate with visual acuity. The studies currently available, however, are inconclusive and lack robust longitudinal data. Vascular imaging demonstrates the potential to aid in the diagnosis, management and monitoring of ROP, alongside retinal examination via indirect ophthalmoscopy and fundus photography.

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Section: Resultsmentioning

confidence: 99%

Vascular imaging findings in retinopathy of prematurity

Rowe,

Belamkar,

Antman

et al. 2023

Acta Ophthalmologica

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“…Reports have shown its utility by describing different patterns of regression, reactivation and response after anti-VEGF, aiding the clinician in the decision to retreat or follow. [91][92][93] However, angiography is not readily available in most centers, and the specialist may rely on clinical examination and to treat the persistent peripheral avascular retina (PPAR), if any. 25 The avascular retina might lead to recurrent ROP.…”

Section: Scenario 3: Intravitreal Anti-vegf Injection In Both Eyesmentioning

confidence: 99%

Role of Anti-Vascular Endothelial Growth Factor (Anti-VEGF) in the Treatment of Retinopathy of Prematurity: A Narrative Review in the Context of Middle-Income Countries

Dogra¹,

Vinekar²

2023

PHMT

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The rise in preterm births and higher survival rates of premature infants have led to a global increase in retinopathy of prematurity (ROP), a vasoproliferative retinal disorder common in premature infants. ROP is one of the leading causes of childhood blindness. Clinical manifestation of ROP ranges from mild abnormal retinal neovascularization to bilateral retinal detachment and vision loss. The incidence of ROP is higher in middle income countries, including India, which has the highest number of global preterm births. Low birth weight and low gestational age are the primary risk factors for ROP; however, anemia, cardiac defects, blood transfusion, apnea, sepsis, respiratory distress syndrome, high exposure to oxygen and poor postnatal weight gain may also contribute to its development. India has stringent ROP screening guidelines revised in 2018, and screening of infants with either birth weight <2000 grams or gestational age <34 weeks is mandated. With an improved understanding of the pathogenesis of ROP in the past decades and advances in clinical research, treatment for ROP has evolved from cryotherapy to laser retinal ablation. Most recently, anti-vascular endothelial growth factor (anti-VEGF) drugs have emerged as a favorable treatment option for zone-I and II ROP. This article reviews the current approaches for ROP treatment in India with a particular focus on anti-VEGF drugs. The article also integrates the understanding of safety and risk-benefit evaluation of the current approaches in ROP management. The review concluded that there is a need to increase the ROP screening not only for preterm and low birth weight but also for optimal gestational age infants with healthy birth weight. Anti-VEGF therapies have shown improved efficacy, although studies are required to establish the long-term safety.

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“…Additionally, anti-VEGF treatment is associated with a lower incidence of high myopia compared to laser therapy ( 6–8 ). However, anti-VEGF agents have been associated with more angiographic abnormalities, such as persistent avascular retina (PAR) and a higher reactivation rate, compared to laser therapy ( 9 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

Vascular development analysis: a study for tertiary anti-vascular endothelial growth factor therapy after second reactivation of retinopathy of prematurity

Zhang,

Peng,

Yang

et al. 2024

Front. Med.

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PurposeTo observe the vascular development results of tertiary anti-vascular endothelial growth factor (anti-VEGF) therapy following spontaneous second reactivation of retinopathy of prematurity (ROP).MethodsThis retrospective study included 22 infants (42 eyes) with Type 1 or aggressive ROP (A-ROP) who received three anti-VEGF drug treatments for ROP from January 2018 to December 2022. The vascular growth, possible associated risk factors, and the retinal vascularization (DB/DF ratio) were assessed.ResultsThe mean follow-up was 17.6 months. After the 3rd intravitreal injection, seven eyes showed complete vascularization (Group 1), while the remaining 35 eyes demonstrated persistent avascular retina (PAR) (Group 2). In Group 2, 17 eyes maintained a stable state and were classified in the regression subgroup. The other 18 eyes developed a 3rd reactivation (reactivation subgroup) and were treated with laser photocoagulation (LPC).Birth weight (BW) was significantly lower in Group 2 than in Group 1 (p < 0.001). The decision tree analysis shows that only infants weighing more than 1,250 g (17.50%) had a chance to achieve complete retinal vascularization. The possibility of PAR was higher in patients with BW <1,250 g than ≥1,250 g (70.00% vs. 12.50%). In addition, most infants with BW ≥ 1,290 g and initial ROP disease in Zone I or posterior Zone II developed PAR.ConclusionTertiary IVR can successfully treat a second ROP reactivation and improve peripheral retinal vascularization. BW is the most significant factor related to complete retinal vascularization. Our decision tree model may be helpful in predicting the prognosis of anti-VEGF drugs in the event of a second ROP reactivation.

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Long-term retinal vasculature abnormalities following intravitreal bevacizumab for retinopathy of prematurity

Cited by 8 publications

References 21 publications

Vascular imaging findings in retinopathy of prematurity

Vascular imaging findings in retinopathy of prematurity

Role of Anti-Vascular Endothelial Growth Factor (Anti-VEGF) in the Treatment of Retinopathy of Prematurity: A Narrative Review in the Context of Middle-Income Countries

Vascular development analysis: a study for tertiary anti-vascular endothelial growth factor therapy after second reactivation of retinopathy of prematurity

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