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

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, https://doi.org/10.3928/15428877-20070501-09 , 2007, Shah et al. in Indian J Ophthalmol 55:75-76, https://doi.org/10.4103/0301-4738.29505 , 2007, Quiroz-Mercado et al. in Semin Ophthalmol 22:109-125, https://doi.org/10.1080/08820530701420082 , 2007).

Keywords: Anti-VEGF; Laser; ROP; Retinopathy of prematurity; Vitreoretinal surgery.

Fig. 1

Spectrum of preplus and plus disease in different left eyes: mild preplus through preplus but insufficient for plus (A–C), and plus disease from mild to severe (D–F). Reprinted from Ophthalmology, Fig. 2A–F), volume 128, Chiang MF et al. [13], with permission from Elsevier

Fig. 2

Aggressive ROP (A-ROP) in right eye showing image of severe plus disease with flat neovascularization and vitreous hemorrhage noted near vitreoretinal traction (arrowheads). Reprinted from Ophthalmology, Fig. 7C), volume 128, Chiang MF et al. [13], with permission from Elsevier

Fig. 3

Right eye of regressed ROP (A) with black arrows showing a line in the place of the previous ridge and stage 3 ROP, and red arrows pointing out vascularization into the peripheral retina 6 weeks after 0.25 mg bevacizumab injection for type 1 ROP (39 weeks PMA). Left eye with type 2 ROP at 37 weeks PMA (B) with spontaneous regression of the ridge and stage 3 ROP followed by vascularization of the peripheral retina at 42 weeks PMA (C). Courtesy of Melissa Chandler, BS, CRA, OCT-c, COT