Anti-angiogenic therapy in the management of retinopathy of prematurity

Abstract

Retinopathy of prematurity (ROP) is a vitreoretinal abnormality that significantly affects premature babies with low birth rates. Despite improved screening and management of these infants, a subset will progress to retinal detachment and permanent visual impairment. Current treatment consists of peripheral laser ablation and subsequent surgical intervention if a detachment occurs. We sought to evaluate the vitreous biochemistry of eyes that progress despite appropriate laser intervention. Additionally, a limited trial of an anti-VEGF (vascular endothelial growth factor) therapy was used in one eye of infants with persistent Plus disease and neovascularization. The anti-VEGF treatment successfully decreases abnormal angiogenesis but does not decrease the proliferative changes associated with retinal detachment. Biochemical analysis of the vitreous of stage 4 ROP eyes shows significantly elevated VEGF and transforming growth factor (TGF-beta) concentrations, and normal levels of other angiogenic factors.