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Ryan K Wong, Irena Tsui; Anti-Vascular Endothelial Growth Factor (VEGF) for Retinopathy of Prematurity: Jules Stein Eye Institute Experience. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5922.
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Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the developing retina and a significant cause of infant blindness. Large multicenter trials with long followup have established laser photocoagulation as the gold standard for management of ROP. However, case series and the recent Bevacizumab Eliminates the Angiogenic Threat of ROP trial have popularized the use of off-label use of anti-VEGF therapy as an alternative treatment. The purpose of this study is to report the management of infants treated with anti-VEGF at the Jules Stein Eye Institute/University of California, Los Angles (UCLA).
A retrospective chart review was conducted on consecutive infants screened for retinopathy of prematurity in the neonatal intensive care unit at the Ronald Regan UCLA Medical Center from January 2012 to December 2013. Babies with type 1 prethreshold disease or worse and treated with anti-VEGF therapy were identified. All infants with at least 6 months of followup at time of publication were included.
Six eyes (4 out-born infants) were included in the study (Table 1). The mean birth weight was 605 grams (range: 500 -690 grams), mean gestational age was 23.4 weeks (range: 23.0 - 24.3 weeks), and mean age at time of anti-VEGF injection (4 eye with ranibizumab and 2 eyes with bevacizumab) was 34.2 weeks (range: 31.6 - 36.3 weeks). All eyes had stage 2 or 3 ROP, posterior zone 2, with plus disease. All eyes showed initial resolution of plus disease and regression of ROP after treatment. All 6 eyes required additional laser treatment, at a mean age of 44.4 weeks (range: 42.9 - 50.4 weeks). Indications for additional laser were reactivation of ROP in 3 eyes (50%), at an average of 6.1 weeks after anti-VEGF treatment, and persistent stage 1, zone 3 ROP in 3 eyes (50%), at an average of 12.9 weeks after anti-VEGF treatment.
Infants after anti-VEGF therapy for ROP may often require supplemental laser photocoagulation for reactivation or persistence of disease within 3 months. Longer term follow up is needed for our patients, as well as more studies on anti-VEGF ideal dosing, adverse effects, and effects on the developing infant.
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