The scientific program of the 2008 Joint Meeting of the American Academy of Ophthalmology (Academy) and European Society of Ophthalmology (SOE) in Atlanta for November 11 includes a clinical study of a promising new treatment for retinopathy of prematurity (ROP).
ROP is often difficult to resolve using current treatments and can result in permanent, severe visual impairment in premature infants when treatment is unsuccessful. ROP encompasses a series of damaging changes in the retina, the area at the back of the eye that relays images to the brain's visual center. These changes may occur because the retina of a baby born before term has not had time to fully develop.
A number of severe visual impairments, including detached retina, glaucoma, cataracts, nearsightedness, and eye misalignment can result from ROP. One abnormal retinal change in ROP is the growth of abnormal blood vessels, which are stimulated by vascular endothelial growth factor, or VEGF. Anti-VEGF medications have been developed to inhibit abnormal vessels and are effective treatments adult eye disorders such as "wet" age-related macular degeneration.
Building on earlier studies that showed good results, Alay S. Banker, MD, and his colleagues, Banker's Retina Clinic and Laser Centre, Gujarat, India, evaluated anti-VEGF therapy in 21 babies (34 eyes) who had or were at high risk for ROP. Fourteen eyes received laser and then anti-VEGF injections; 12 eyes received anti-VEGF injection only; and six eyes received anti-VEGF, then laser treatment. All babies were examined one day after treatment, weekly for a month, and monthly thereafter. In all babies' eyes---including those that received anti-VEGF treatment only--- the abnormal blood vessels resolved without further treatment, and no adverse results were seen in any eyes or in the babies' general health status in follow-up exams at about 37 weeks after treatment (mean age: 37.5 weeks).
Dr. Alay said anti-VEGF treatment provided rapid, effective treatment for ROP that avoided the complications and risks of laser and cryotherapy (freezing) vessel treatments, and was simpler and safer to provide to medically fragile babies. As abnormal vessels receded, normal retinal vessels slowly grew in their place. Dr. Alay says that this treatment could be particularly important in developing countries where laser facilities might not be available; also anti-VEGF treatment could "buy time" to transport babies when advanced centers are available. In some cases, further treatment might prove unnecessary.
Larger, randomized clinical trials will be necessary to establish the safety and efficacy of anti-VEGF therapy as a first or subsequent treatment for ROP. Such a study is currently underway in the US.
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