Anti-VEGF therapy has an important role in the current management of retinopathy of prematurity (ROP), but there are many unanswered questions surrounding its use, and particularly regarding its systemic safety, said speakers at the inaugural Retina World Congress.
Presenting the Chilean experience using anti-VEGF therapy to treat ROP, Paola Dorta, MD, said it is now considered as primary treatment, depending on the zone of the disease, and used as an adjunct in treating ROP retinal detachments.
“The use of anti-VEGF drugs for the management of ROP was a logical choice for us for many reasons, and in 2008 we started using bevacizumab (Avastin, Genentech) to treat eyes that had progression of disease despite laser," said Dr. Dorta, Fundación KYDOFT, Santiago, Chile. "Then we used it in babies with posterior zone I disease without macular development and subsequently as first-line therapy for type 1 ROP.”
Dr. Dorta and colleagues published their results using bevacizumab 0.625 mg as primary treatment for zone I ROP in 12 eyes of 7 patients. All eyes in the series showed regression and none needed additional intervention. Retinal vascularization after ROP regression followed a normal pattern, although it occurred relatively slowly. There was no retina destruction and the refractive outcomes were better than after laser photocoagulation, she said.
Discussing anti-VEGF injection as an adjunct to vitreoretinal surgery in treating ROP detachments, Dr. Dorta explained that vascular activity is a major problem when operating on ROP retinal detachments.
“Delaying surgery for the eye to become spontaneously quiet can result in progression of the detachment. Our solution is to use anti-VEGF therapy 1 week preoperatively, and we have seen this leads to a very significant reduction in vascular activity,” she said.