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      Laser versus Anti-VEGF: A Paradigm Shift for Treatment-Warranted Retinopathy of Prematurity

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          Abstract

          Retinopathy of prematurity (ROP), a leading cause of childhood blindness, has historically been associated with blindness from overgrowth of blood vessels from the retina into the vitreous that lead to complex retinal detachments. Our understanding of ROP has evolved with the survival of extremely low-birthweight infants and includes not only overgrowth of blood vessels, but also insufficient developmental retinal vascular growth in early phases of the disease. Our current treatments of ROP have focused on methods to improve perinatal and prenatal care, reduce premature birth, and prevent early phases of ROP. Nonetheless, addressing vasoproliferation in treatment-warranted eyes remains the mainstay of management. Two main treatment strategies co-exist today: laser treatment, which has been the standard of care since the 1990s, and anti-VEGF injections, which have been used since early reports in 2007 (Travassos et al. in Ophthalmic Surg Lasers Imaging, 38:233–237, 10.3928/15428877-20070501-09, 2007, Shah et al. in Indian J Ophthalmol 55:75–76, 10.4103/0301-4738.29505, 2007, Quiroz-Mercado et al. in Semin Ophthalmol 22:109–125, 10.1080/08820530701420082, 2007).

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          Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis

          Saifon Chawanpaiboon, Joshua P. Vogel, Ann-Beth Moller … (2018)
          Summary Background Preterm birth is the leading cause of death in children younger than 5 years worldwide. Although preterm survival rates have increased in high-income countries, preterm newborns still die because of a lack of adequate newborn care in many low-income and middle-income countries. We estimated global, regional, and national rates of preterm birth in 2014, with trends over time for some selected countries. Methods We systematically searched for data on preterm birth for 194 WHO Member States from 1990 to 2014 in databases of national civil registration and vital statistics (CRVS). We also searched for population-representative surveys and research studies for countries with no or limited CRVS data. For 38 countries with high-quality data for preterm births in 2014, data are reported directly. For countries with at least three data points between 1990 and 2014, we used a linear mixed regression model to estimate preterm birth rates. We also calculated regional and global estimates of preterm birth for 2014. Findings We identified 1241 data points across 107 countries. The estimated global preterm birth rate for 2014 was 10·6% (uncertainty interval 9·0–12·0), equating to an estimated 14·84 million (12·65 million–16·73 million) live preterm births in 2014. 12· 0 million (81·1%) of these preterm births occurred in Asia and sub-Saharan Africa. Regional preterm birth rates for 2014 ranged from 13·4% (6·3–30·9) in North Africa to 8·7% (6·3–13·3) in Europe. India, China, Nigeria, Bangladesh, and Indonesia accounted for 57·9 million (41×4%) of 139·9 million livebirths and 6·6 million (44×6%) of preterm births globally in 2014. Of the 38 countries with high-quality data, preterm birth rates have increased since 2000 in 26 countries and decreased in 12 countries. Globally, we estimated that the preterm birth rate was 9×8% (8×3–10×9) in 2000, and 10×6% (9×0–12×0) in 2014. Interpretation Preterm birth remains a crucial issue in child mortality and improving quality of maternal and newborn care. To better understand the epidemiology of preterm birth, the quality and volume of data needs to be improved, including standardisation of definitions, measurement, and reporting. Funding WHO and the March of Dimes.
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            Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity.

            Helen Mintz-Hittner, Kathleen A. Kennedy, Alice Chuang (2011)
            Retinopathy of prematurity is a leading cause of childhood blindness worldwide. Peripheral retinal ablation with conventional (confluent) laser therapy is destructive, causes complications, and does not prevent all vision loss, especially in cases of retinopathy of prematurity affecting zone I of the eye. Case series in which patients were treated with vascular endothelial growth factor inhibitors suggest that these agents may be useful in treating retinopathy of prematurity. We conducted a prospective, controlled, randomized, stratified, multicenter trial to assess intravitreal bevacizumab monotherapy for zone I or zone II posterior stage 3+ (i.e., stage 3 with plus disease) retinopathy of prematurity. Infants were randomly assigned to receive intravitreal bevacizumab (0.625 mg in 0.025 ml of solution) or conventional laser therapy, bilaterally. The primary ocular outcome was recurrence of retinopathy of prematurity in one or both eyes requiring retreatment before 54 weeks' postmenstrual age. We enrolled 150 infants (total sample of 300 eyes); 143 infants survived to 54 weeks' postmenstrual age, and the 7 infants who died were not included in the primary-outcome analyses. Retinopathy of prematurity recurred in 4 infants in the bevacizumab group (6 of 140 eyes [4%]) and 19 infants in the laser-therapy group (32 of 146 eyes [22%], P=0.002). A significant treatment effect was found for zone I retinopathy of prematurity (P=0.003) but not for zone II disease (P=0.27). Intravitreal bevacizumab monotherapy, as compared with conventional laser therapy, in infants with stage 3+ retinopathy of prematurity showed a significant benefit for zone I but not zone II disease. Development of peripheral retinal vessels continued after treatment with intravitreal bevacizumab, but conventional laser therapy led to permanent destruction of the peripheral retina. This trial was too small to assess safety. (Funded by Research to Prevent Blindness and others; ClinicalTrials.gov number, NCT00622726.).
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              Mechanisms and management of retinopathy of prematurity.

              M Hartnett, John S. Penn (2012)
              Article 0 comments Cited 185 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                M. Elizabeth Hartnett: me.hartnett@stanford.edu
                Andreas Stahl: andreas.stahl@med.uni-greifswald.de
                Journal
                Journal ID (nlm-ta): Ophthalmol Ther
                Journal ID (iso-abbrev): Ophthalmol Ther
                Title: Ophthalmology and Therapy
                Publisher: Springer Healthcare (Cheshire )
                ISSN (Print): 2193-8245
                ISSN (Electronic): 2193-6528
                Publication date (Electronic): 19 June 2023
                Publication date PMC-release: 19 June 2023
                Publication date (Print): October 2023
                Volume: 12
                Issue: 5
                Pages: 2241-2252
                Affiliations
                [1 ]GRID grid.168010.e, ISNI 0000000419368956, Byers Eye Institute at Stanford University, , Stanford University, ; 2452 Watson Court, Palo Alto, CA 94303 USA
                [2 ]GRID grid.5603.0, Chair for Ophthalmology, , University Medicine Greifswald, Germany, ; Ferdinand Sauerbruch Strasse, 17475 Greifswald, Germany
                Article
                Publisher ID: 744
                DOI: 10.1007/s40123-023-00744-7
                PMC ID: 10442041
                PubMed ID: 37337024
                SO-VID: 27756009-544e-4f55-a17b-355ec1db6446
                Copyright © © The Author(s) 2023
                License:

                Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 11 April 2023
                Date accepted : 23 May 2023
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100001818, Research to Prevent Blindness;
                Award ID: unrestricted
                Funded by: FundRef http://dx.doi.org/10.13039/100000053, National Eye Institute;
                Award ID: R01 EY015130
                Award ID: R01 EY017011
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100009109, Pharmaceuticals Bayer;
                Funded by: FundRef http://dx.doi.org/10.13039/100008792, Novartis Pharma;
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © Springer Healthcare Ltd., part of Springer Nature 2023

                Keywords: vitreoretinal surgery,laser,anti-vegf,retinopathy of prematurity,rop
                Data availability:
                Keywords: vitreoretinal surgery, laser, anti-vegf, retinopathy of prematurity, rop

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