From the Guidelines
Treatment guidelines for retinopathy of prematurity (ROP) should prioritize timely intervention with laser photocoagulation or intravitreal anti-VEGF injections to prevent vision loss, as the pathophysiology involves abnormal retinal vascularization due to hyperoxia-induced suppression of VEGF followed by hypoxia-induced VEGF surge. The current understanding of ROP, as described in the study 1, highlights the importance of managing arterial oxygen levels to prevent cor pulmonale in chronic lung disease of infancy and childhood, while also considering the need to carefully manage arterial oxygen levels when the retina is not fully vascularized. Key aspects of ROP treatment include:
- Regular screening of at-risk infants, starting at 4-6 weeks chronological age or 31 weeks postmenstrual age for infants born at less than 30 weeks gestation or weighing less than 1500 grams
- Treatment indicated for type 1 ROP, which includes zone I ROP with plus disease, zone I stage 3 ROP, or zone II stage 2 or 3 ROP with plus disease
- Primary treatments: laser photocoagulation and intravitreal anti-VEGF injections, such as bevacizumab (0.625-0.75 mg), ranibizumab (0.2 mg), or aflibercept (0.4-1 mg)
- Surgery (vitrectomy or scleral buckling) reserved for advanced cases with retinal detachment
- Close follow-up essential after treatment, as recurrence can occur, particularly after anti-VEGF therapy
- Long-term ophthalmologic monitoring necessary, as treated children remain at higher risk for refractive errors, strabismus, amblyopia, and glaucoma, as noted in the study 1.
From the Research
Treatment Guidelines for Retinopathy of Prematurity
The treatment guidelines for retinopathy of prematurity (ROP) involve various approaches, including laser photocoagulation, anti-vascular endothelial growth factor (VEGF) therapy, and other potential treatments. The key considerations for treatment are:
- Laser Photocoagulation: This is the standard treatment for type 1 ROP, particularly in zone II 2, 3, 4.
- Anti-VEGF Therapy: This treatment has gained popularity, especially for type 1 ROP in zone I, due to its potential to reduce ocular side effects compared to laser photocoagulation 2, 5, 4.
- Comparison of Treatments: Studies have compared the efficacy and safety of anti-VEGF therapy versus laser photocoagulation, with some findings indicating that anti-VEGF therapy may reduce the risk of refractive errors and may have similar outcomes in terms of mortality and retinal detachment 5.
- Long-term Outcomes: A multicentre study found that the initial treatment procedure (anti-VEGF or laser therapy) was not associated with specific treatment outcomes, but subgroup analysis showed that anti-VEGF-treated eyes had better visual acuity and higher spherical equivalent in zone I ROP 6.
Key Points to Consider
- Zone and Stage of ROP: The zone and stage of ROP are crucial in determining the treatment approach, with zone I ROP potentially benefiting more from anti-VEGF therapy 2, 6.
- Plus Disease: The presence of plus disease is an important factor in determining the treatment approach, with type 1 ROP and plus disease requiring prompt treatment 2, 3.
- Follow-up and Monitoring: Regular follow-up and monitoring are essential to detect and manage potential complications associated with ROP treatment, regardless of the approach used 2, 5, 6.