Vascular endothelial growth factor antagonist therapy for retinopathy of prematurity

Abstract

In this article, the growing problem of retinopathy of prematurity (ROP) worldwide, treatments for severe ROP including standard-of-care laser treatment, and the need for new treatments are discussed. Also discussed are the reasons to consider inhibiting the vascular endothelial growth factor (VEGF) signaling pathway in severe ROP and the concerns about broad VEGF inhibition. Finally, the potential role of VEGF in ROP based on studies in animal models of oxygen-induced retinopathy, the effects of anti-VEGF based on basic research data, and the clinical relevance of these data are covered.

Keywords: Angiogenesis; Bevacizumab; Intravitreal neovascularization (IVNV); Oxygen-induced retinopathy (OIR); Physiologic retinal vascular development (PRVD); Vascular endothelial growth factor.

Figure 1

As the eye grows there is increased avascular retina peripherally and thus an increase in area between laser spots. Avascular retina leads to hypoxia, which can stimulate angiogenic signaling through hypoxia inducible factors that translocate to the nucleus and bind to DNA promoter to cause transcription of multiple angiogenic factors, like VEGF, erythropoietin, angiopoietins, as examples.