&lt;p&gt;Hypertension and Ischemic Stroke After Aflibercept for Retinopathy of Prematurity&lt;/p&gt;

Bazvand, Fatemeh; Pour, Elias Khalili; Gharehbaghi, Golnaz; Faghihi, Hooshang; Khodabandeh, Ali; Bahar, Mohammadreza Mehrabi; Riazi-Esfahani, Hamid

doi:10.2147/imcrj.s258881

Cited by 9 publications

(5 citation statements)

References 8 publications

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“…Data from the post-marketing aflibercept Global Safety Database showed that the rate of retinal arterial occlusion, vasculitis, or severe vision loss was 0.9 per 10,000 aflibercept injections (21). A case of complete arrest of retinal vascular growth until 7 months after receiving intravitreal injection of aflibercept for aggressive posterior ROP might indicate that aflibercept can affect normal vascular growth (22). However, there were no FA images in this publication.…”

Section: Discussionmentioning

confidence: 85%

Case Report: A Case of Cotton-Wool Spots After Intravitreal Injection of Conbercept in an Infant With Incontinentia Pigmenti

Liang

Yang

et al. 2021

Front. Med.

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Introduction: Incontinentia pigmenti (IP) is a rare X-linked neuroectodermal dysplasia affecting multiple organs. One of its most significant ophthalmic manifestations is retinal neovascularization due to retinal ischemia, which has been traditionally treated with laser photocoagulation or cryotherapy. The application of anti-vascular endothelial growth factor (VEGF) has been reported for the treatment of retinopathy of IP with beneficial results. However, clinicians should be aware of the possible ocular and systemic side effects of the intravitreal injection of anti-VEGF agents.Case Report: A 4-month-old female infant with IP was treated with intravitreal injection of conbercept in both eyes. However, cotton-wool spots were noticed in the left eye 1 week after the injection. Laser photocoagulation was performed as an adjunct treatment. The cotton-wool spots were absorbed 1 month after the first intravitreal injection and have eventually disappeared.Discussion: The cotton-wool spots, after intravitreal injection of conbercept for the treatment of IP, indicated severe retinal ischemia resulting from the neutralization of excessive VEGF, which was shown on fundus photograph and fluorescent angiography. Anti-VEGF agents could cause retinal arteriolar vasoconstriction and artery occlusion on rare occasions. The administration of anti-VEGF agents in pediatric cases with severe neovascularization and retinal ischemia should be carefully considered.

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Section: Discussionmentioning

confidence: 85%

Case Report: A Case of Cotton-Wool Spots After Intravitreal Injection of Conbercept in an Infant With Incontinentia Pigmenti

Liang

Yang

et al. 2021

Front. Med.

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“…Bazvand et al . 26 reported a case of CVA and systemic hypertension crisis after the prescription of IVA and complete retinal vascular arrest until 7 months after injection for APROP.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Outcomes of Intravitreal Bevacizumab and Aflibercept in Type 1 Prethreshold Retinopathy of Prematurity in Posterior Zone Ii

Milani

Bagheri

Niyousha

et al. 2022

Journal of Current Ophthalmology

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Purpose: To evaluate the efficacy and safety of intravitreal injection (IVI) of bevacizumab (IVB) versus aflibercept (IVA) in premature infants with type 1 prethreshold retinopathy of prematurity (ROP) in the posterior Zone II. Methods: The study was a multicenter, historical cohort of premature newborns diagnosed with type 1 prethreshold ROP in the posterior Zone II, treated with IVB or IVA. Demographic features, complications, and treatment outcomes were then compared between the two groups. Results: Seventy-six patients received aflibercept (the IVA group), and 210 received bevacizumab (the IVB group). The two groups were not significantly different in terms of postmenstrual age (PMA) at the time of ROP diagnosis and other known risk factors for ROP development and progression. All eyes in both the groups responded to IVI; however, recurrence was observed in four eyes (1.9%) in the IVB group and 12 (15.8%) in the IVA group (P = 0.001). Recurrence occurred 9.1 ± 0.83 (5–12) and 15.5 ± 0.98 (12–18) weeks after primary treatment in the IVB and IVA groups, respectively (P = 0.000). In the IVA group, retinal vascularization was completed in 38.18 ± 6.5 weeks (21–48) after IVI, and it happened in 23.86 ± 9.3 weeks (13–60) in the IVB group (P = 0.009). Furthermore, vascularization reached the peripheral retina in 73.25 ± 6.5 (56–84) and 58.75 ± 8.8 (45–93) weeks, PMA in the IVA and IVB groups, respectively (P = 0.03). No acute postoperative complications were observed in the treated eyes in either group. Conclusion: This study shows that both IVA and IVB are effective and well tolerated for the management of type 1 prethreshold ROP in the posterior Zone II; however, IVA needs a significantly longer time for vascularization completion and has a higher recurrence rate compared with IVB.

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“…Bazvand 55 reported an ischemic stroke just one week after Aflibercept for APROP in an infant with a history of hypertension. The potential increased risk of thromboembolic events may be linked to systemic cardiovascular comorbidities and the long half-life of Aflibercept.…”

Section: Safetymentioning

confidence: 99%

New trends in intravitreal anti-VEGF therapy for ROP

Beccasio

Mignini

Caricato

et al. 2022

European Journal of Ophthalmology

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Retinopathy of Prematurity (ROP) affects premature newborns, and it can cause childhood blindness and visual impairment if untreated. The understanding of the pathogenetic role of Vascular Endothelial Growth Factor (VEGF) has led to development of therapeutic strategies such as intravitreal anti-VEGF drugs. We reported drug efficacy and ROP recurrence rates, extrapolated from the reviewed studies. Association of Pegabtanib and laser photocoagulation confers efficacy in the regression of ROP stage 3 plus in zone I / II in 89.7% of treated eyes, reducing the recurrence rate to 14.6% compared to 50% of laser therapy alone. Irrespective of the dose, Ranibizumab demonstrated average efficacy greater than 75% on regression of active disease with the highest rates of the dose of 0.1 mg (92.5%). The recurrence, on the other hand, is the highest among this new anti-VEGF agents and is around an average of 41.5%, which records the highest values in the case of Aggressive Posterior Rop (APROP). Aflibercept at a dose of 1 mg demonstrated average efficacy of about 81.9% of treated infants, analyzing significantly fewer studies than Ranibizumab. The recurrence rate stands at an average of 28.9%, especially in the later forms of ROP. Using a dose of 0.25 mg of Conbercept, the disease regression rate is currently on average 83%, with an average recurrence rate of 15.24%, the peak of which was observed in cases of ROP in zone I. Further studies are needed to prove safety at long term, because,at the moment, only short-term data are available.

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<p>Hypertension and Ischemic Stroke After Aflibercept for Retinopathy of Prematurity</p>

Cited by 9 publications

References 8 publications

Case Report: A Case of Cotton-Wool Spots After Intravitreal Injection of Conbercept in an Infant With Incontinentia Pigmenti

Case Report: A Case of Cotton-Wool Spots After Intravitreal Injection of Conbercept in an Infant With Incontinentia Pigmenti

Comparison of Clinical Outcomes of Intravitreal Bevacizumab and Aflibercept in Type 1 Prethreshold Retinopathy of Prematurity in Posterior Zone Ii

New trends in intravitreal anti-VEGF therapy for ROP

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