Abstract
To report the effects of anti-vascular endothelial growth factor (VEGF) treatment in vascular development for cases of acute retinopathy of prematurity (ROP) using fluorescent angiography (FA) and to present the results of our observational approach to retinal sequelae. A total of 31 eyes in 19 patients with a history of treatment with anti-VEGF agents for classic type 1 ROP and aggressive posterior ROP who underwent FA between March 2014 to February 2020 were reviewed. Angiograms of retinal developmental features of patients aged 4months to 6years were examined. The patients mean gestational age were 26.06 ± 1.90weeks and the mean birth weight were 837.68 ± 236.79g. All cases showed various abnormalities at the vascular and avascular retina, and the posterior pole. All but one case showed a peripheral avascular area on FA evaluation during the follow-up period. We did not apply prophylactic laser treatment to these avascular retina. On the final examination, except one case, we did not observe any late reactivation in any patients. FA is an important tool for assessing vascular maturation in infants. Every leakage should not be assumed to be evidence of late activation, as some leaks may be related to vascular immaturity. Retinal vascularization may not be completed in all patients, however this does not mean that all these patients need prophylactic laser application. Our observational approach may be more daring than the reports frequently encountered in the literature, but it should be noted that unnecessary laser treatment will also eliminate all the advantages of anti-VEGF treatment.
Highlights
Retinopathy of prematurity (ROP) is a proliferative retinopathy of premature infants that has been accepted as a major cause of irreversible visual deterioration and is present in both developed and developing countries [1,2,3,4]
Retinal vascularization may not be completed in all patients, this does not mean that all these patients need prophylactic laser application
Our observational approach may be more daring than the reports frequently encountered in the literature, but it should be noted that unnecessary laser treatment will eliminate all the advantages of anti-vascular endothelial growth factor (VEGF) treatment
Summary
Retinopathy of prematurity (ROP) is a proliferative retinopathy of premature infants that has been accepted as a major cause of irreversible visual deterioration and is present in both developed and developing countries [1,2,3,4]. The prospective randomized stratified multicenter clinical trial Bevacizumab Eliminates the Angiogenic Threat of Retinopathy of Prematurity Study (BEAT-ROP) assessed intravitreal injection of bevacizumab (IVB) monotherapy [7]. It reported that when considering both Zone 1 and posterior Zone 2 ROP together, IVB therapy was more effective than LPT [7]. Treatment with IVB, a humanized monoclonal antibody against VEGF-A, has obtained popularity after the publication of the BEAT-ROP study. Ranibizumab, an antibody fragment of humanized antiVEGF monoclonal antibody, is an alternative for intravitreal anti-VEGF therapy in ROP as well. Ranibizumab has a shorter half- life, higher binding affinity to VEGF than bevacizumab, and antibodies lacking a crystallizable fragment, theoretically, may provoke fewer systemic adverse affects than treatment with bevacizumab [8]
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