Serum concentrations of vascular endothelial growth factor in relation to retinopathy of prematurity

Abstract

Background The role of vascular endothelial growth factor (VEGF) in the pathogenesis of retinopathy of prematurity (ROP) has been clearly established. However, little is known about temporal changes in circulating VEGF concentrations in the preterm infant. The objective was to determine the longitudinal serum concentrations of VEGF in relation to ROP. Methods This study included 52 infants born at <31 wk gestational age (non-ROP n = 33, nonproliferative ROP n = 10, treated for ROP n = 9). VEGF concentrations were analyzed in blood samples collected at birth, at 3 d postnatal age, and then weekly until at least a gestational age of 35 wk. Results VEGF concentrations at birth did not differ between groups, independent of later ROP status. In contrast, VEGF serum concentrations were significantly higher at first detection of ROP in infants who were later treated for ROP compared to infants without ROP. At the time of laser therapy, serum VEGF concentrations did not differ between groups. Conclusion Circulatory concentrations of VEGF, in infants who later developed severe ROP, were elevated at the time when ROP first was detected but not at the time when current treatment most often occurred. This supports the need for further studies of circulating VEGF in relation to the timing of ROP treatment.

Aggressive Posterior Retinopathy of Prematurity Is Associated with Multiple Infectious Episodes and Thrombocytopenia

“…Platelets store, transport, and deliver VEGF [17]. Increased local and systemic VEGF levels have been detected in the proliferative phase of ROP and primarily at the first detection of ROP [18]. However, it is not clear whether thrombocytopenia disturbs the retinal VEGF balance and how these disturbances might affect each phase of ROP.…”

Pathophysiology, screening and treatment of ROP: A multi-disciplinary perspective

“…(Msall et al, 2004, Hou et al, 2011. Recent follow-up data from the Extremely Preterm Infants in Sweden Study (EXPRESS; infants <27 weeks' gestation) at 6.5 years of age showed that 37.9% had ophthalmologic abnormalities compared with 6.2% of matched controls, and 4.8% had visual impairment (<20/60 vision) and 2.1% were blind (Hellgren 2016). OCT undertaken in a subset of the cohort at the same age showed central macula thickness to be significantly increased in the extremely premature group (Molnar 2017).…”

The association between systemic vascular endothelial growth factor and retinopathy of prematurity in premature infants: a systematic review

“…A recent study by Hellgren et al 14 found that VEGF concentration in premature infants who later developed ROP was increased when ROP was first detected but the level declined by the time the premature infants received treatment. There was no correlation between cord VEGF concentration and ROP status at a later stage.…”

“…Two studies were carried out using cord blood,7 8 five studies compared VEGF measurements from venous blood (mostly serum levels)9–13 and in the most recent study, both cord and venous VEGF measurements were used 14. In three other studies, the relationship between IVB and VEGF was investigated15–17 and in one study, tissue specimen from a deceased neonate was analysed 18.…”

“…In studies that measured VEGF in cord blood, low VEGF (at birth) was associated with ROP in one8 and no difference in two others 7 14. Postnatal venous VEGF measurement from four studies showed no difference in VEGF level between premature infants with and without ROP,10–12 17 one study showed increased VEGF levels in premature infants with ROP,9 another study found serum VEGF to be low in premature infants with ROP13 and the most recent study demonstrated an initial increase in serum VEGF followed by a decline at the time of treatment 14. These contradictory results indicate that we are yet to fully understand the role of VEGF in human premature infants and question the rationale of treating ROP with anti-VEGF.…”