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OSN Europe: How do you manage children who have persistent plus disease or progressive ROP after laser or anti-VEGF treatment?
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Point
Anti-VEGF may be a good option in several cases
Various factors must be considered to decide the next step in the management of progression after treatment for type 1 ROP: type of primary treatment, zone and stage of disease. If there is persistent plus disease and no retinal detachment in an eye treated with laser for zone 2 ROP, treatment of skipped areas should be done. If adequate treatment was given (near confluent spots in all the avascular area), the use of an intravitreal anti-VEGF drug is advisable.
If the eye had zone 1 ROP and was initially treated with laser, the secondary treatment would depend on the zone where the vessels are located. If vessels are still in zone 1, the injection of an intravitreal anti-VEGF drug could be performed. If vessels are in zone 2, more laser should be applied if skipped areas are found.
Andres Kychenthal
If there is progression after primary treatment with an anti-VEGF and no retinal detachment is present, the zone where the vessels are located will determine the secondary treatment. If vessels are still in zone 1, a re-injection of anti-VEGF might be performed. If vessels are in zone 2, laser should be applied. It is worth noting that the patterns of regression after the use of anti-VEGFs are distinct and not well known. This should be considered to avoid unnecessary re-treatments.
If progression of the disease produces a retinal detachment, the eye’s vascular activity should be evaluated in order to define the subsequent therapeutic actions.
Vascular activity is a major problem when operating ROP retinal detachment. If there is vascular activity, then the injection of an anti-VEGF 1 week before vitreoretinal surgery is recommended. The vascular regression induced by the anti-VEGF will allow performing the intervention in a quiet eye without the drawback of waiting for the eye to become spontaneously vascularly inactive, which can lead to progression of the detachment.
Andres Kychenthal, MD, is from the Kydoft Foundation, Santiago, Chile. Disclosure: Kychenthal reports no relevant financial disclosures.
Click here to read the full Point/Counter published in Ocular Surgery News Europe Edition, October 2015.