Review of the latest treatments for retinopathy of prematurity: laser photo-ablation versus intravitreal anti-VEGF agents in the management of high-risk pre-threshold (type 1) disease

Abstract

From a global perspective, retinopathy of prematurity (ROP) remains a major cause of visual impairment and blindness. For the past several decades, peripheral retinal laser photo-ablation has been, and currently remains the gold standard for the treatment of high-risk ROP. More recently, suppression of VEGF by way of intravitreal injection of bevacizumab has emerged as a promising approach to manage high-risk ROP. Currently, however, there remain many unanswered questions regarding its dosing, safety and long-term efficacy that preclude the universal adoption of intravitreal bevacizumab as the primary treatment modality for high-risk ROP.

Keywords:

• anti-VEGF
• bevacizumab eliminates the angiogenic threat of retinopathy of prematurity
• bevacizumab
• early treatment of ROP
• laser
• photo-ablation
• retinopathy of prematurity

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

Key issues

• From a global perspective, retinopathy of prematurity is, unequivocally, a growing problem.

• The safety and efficacy of peripheral laser photo-ablation in the management of type I prethreshold ROP have been well established by the Early Treatment for Retinopathy of Prematurity (ETROP) trials for many years.

• Peripheral laser photo-ablation remains the current therapeutic gold standard for managing type I prethreshold ROP.

• Despite its implication in a variety of pathophysiologic processes when overexpressed, VEGF is a vital physiologic growth factor that plays a key role in the development and maintenance of nearly every organ system in the human body.

• An intravitreal injection of bevacizumab per BEAT-ROP study protocol has been shown to suppress systemic VEGF levels in neonates with ROP, and these effects can persist for months.

• The postoperative course in eyes following bevacizumab injection is unpredictable and can be associated with late reactivation of disease, abnormal macular vascular architecture, hyaloidal contracture and late retinal detachment.

• The use of intravitreal injections of bevacizumab in the management of any stage of ROP remains controversial due to the lack of clear dosing, safety and efficacy data.

Notes