Efficacy of Anti-VEGF in Treatment of Retinopathy of Prematurity

Abstract

Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that affects premature infants. Vascular endothelial growth factor (VEGF) has been implicated in the pathogenesis of ROP. Anti-VEGF agents can potentially inhibit abnormal vessel growth in ROP. This study aimed to evaluate the efficacy of anti-VEGF (bevacizumab) in treatment of ROP. A prospective study was conducted on 75 patients including 70 adults and 5 ROP babies who received intravitreal injection of bevacizumab (Avastin). Distant visual acuity, slit lamp examination, indirect ophthalmoscopy and optical coherence tomography (OCT) were assessed at baseline, immediate, 1 week and 4 weeks post injection. Statistically significant improvement was observed in distant visual acuity and reduction in macular thickness after Avastin injection. At 4 weeks, best corrected visual acuity of 6/6 was attained by 15 adults and 3 ROP babies. OCT revealed decreased macular edema with mean reduction of 115.29μm. ROP subjects showed greater visual gain (mean acuity improvement - 2.4 lines) as compared to adults (mean acuity improvement - 1.52 lines). Significant correlation was found between better visual acuity and macular thickness less than 300μm. Intravitreal Avastin resulted in rapid regression of neovascularization in ROP. No ocular or systemic complications were observed. Single injection controlled disease progression in majority of cases. Anti-VEGF agents can be considered as primary modality for treating type 1 ROP due to their safety, efficacy and long-term benefits. Larger studies are required to establish optimal dosage and long-term effects.