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2015 ; 112
(43
): 730-5
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Screening and Treatment in Retinopathy of Prematurity
#MMPMID26568177
Stahl A
; Göpel W
Dtsch Arztebl Int
2015[Oct]; 112
(43
): 730-5
PMID26568177
show ga
BACKGROUND: More than 11 000 children are examined for possible retinopathy of
prematurity in Germany each year, and 2-5% of them are treated for it. Even
though screening and treatment programs are in place, the affected children can
still suffer visual impairment. METHODS: In this article, we summarize the
pathogenesis, screening, and treatment of retinopathy of prematurity on the basis
of a selective review of pertinent literature, retrieved by a PubMed search. The
article centers on publications from 2011 to 2015 on the new option of treatment
with VEGF inhibitors and discusses it in comparison to laser therapy. RESULTS:
All premature neonates with a low gestational age at birth, low birth weight, or
prolonged exposure to supplemental oxygen must undergo screening by an
ophthalmologist. Laser therapy is effective for stages 1-3 and for aggressive
posterior retinopathy of prematurity. Its disadvantages are the induction of
scarring and the development of severe myopia in 17-40% of the children so
treated. Anti-VEGF treatment (VEGF = vascular endothelial growth factor) does not
induce any visible scarring and seems to cause less myopia, but long-term data on
safety, dosing, and the choice of anti-VEGF drug are still lacking. CONCLUSION:
The available evidence for anti-VEGF treatment is on a much lower level than the
evidence for laser therapy. Anti-VEGF may be a way to avoid the disadvantages of
laser therapy (scarring and severe myopia). Unlike laser therapy, however, the
intravitreal injection of VEGF inhibitors may suppress systemic VEGF levels and
potentially harm the developing brain, lungs, or other organs. The currently open
questions about anti-VEGF treatment concern its dosing, choice of drug, and
long-term safety.
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