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Anti-VEGF therapy may be an option for stage 3, zone 1 ROP
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VANCOUVER, British Columbia — Intravitreal anti-VEGF therapy appears to have a role in treatment of zone 1 retinopathy of prematurity, but treatment effect is not as pronounced in zone 2 disease.
Among patients followed in the BEAT-ROP (Bevacizumab eliminates the angiogenic threat of retinopathy of prematurity) clinical trial, only one of 33 patients with stage 3, zone 1 ROP treated with a 0.625 mg dose of Avastin (bevacizumab, Genentech) had a recurrence of disease requiring an additional injection through 54 weeks postmenstrual age. However, 16 of 34 patients with stage 3, zone 1 ROP treated with laser required re-treatment over the course of the study.
Results were less robust among patients with zone 2 ROP, Khaled A. Tawansy, MD, said at the American Society of Retina Specialists annual meeting, with a similar number of bevacizumab- and laser-treated patients requiring re-treatment. However, Dr. Tawansy said, there may be issues specific to anti-VEGF use that would require closer follow-up than usual.
"Because the avascular retina is not ablated," Dr. Tawansy said, "there may be persistent peripheral ischemia that can potentially lead to recurrent plus disease, late neovascular or fibrotic proliferation and macular dragging, or tractional retinal detachment."
Despite appropriate and timely treatment, zone 1, stage 3 retinopathy of prematurity and treatment-requiring posterior zone 2 ROP remain a clinical challenge. There have been an increasing number of published reports describing the effectiveness of intravitreal anti-VEGF therapy for treatment requiring ROP. Indeed, intravitreal anti-VEGF therapy will decrease neovascularization and may stop the progression of ROP, but the long-term effects and complications of this treatment have not been fully elucidated.
One series, reported by Martinez-Castellanos and colleagues, showed no systemic adverse events at 4 years’ follow-up for children treated with intravitreal bevacizumab for treatment-requiring ROP. Regardless, more support is needed to confidently assess the long-term outcomes of intravitreal anti-VEGF for ROP.
Regarding administration outside of a clinical trial, there remains some debate. Some would recommend first discussing the off-label use of anti-VEGF for ROP with one’s institutional review board. However, there are others who would advocate that a thorough informed consent is all that is necessary if the physician feels that anti-VEGF therapy is the best possible option for the patient. Anti-VEGF therapy has also been considered for use as an adjunct to surgery in ROP.
The BLOCK-ROP study and BEAT-ROP study will help bring us closer to understanding the safety and efficacy of anti-VEGF therapy in premature neonates with treatment-requiring ROP.
– R.V. Paul Chan, MD, FACS
OSN
Pediatrics/Strabismus Board Member
Reference:
- Martinez-Castellanos MA, Quiroz-Mercado H, Guerrero-Naranjo J, Garcia-Aguirre G, Chan RV. Antiangiogenic therapy In the treatment for retinopathy of prematurity: four years follow up. ARVO 2010, poster presentation (5294/A147).