Anti-VEGF therapy for Zone I retinopathy of prematurity (ROP) is associated with better structural and functional outcomes than laser therapy, but also a longer recurrence risk period, said Helen A. Mintz-Hittner, MD.
Read the other side of the debate: Treating ROP: Laser associated with high success rate for retinopathy of prematurity
“The risk for recurrence after anti-VEGF therapy persists until 60 to 70 weeks adjusted age,” said Dr. Mintz-Hittner. “The long, tedious monitoring for recurrence may be daunting for some people and lead them to question whether the benefits of better visual field and acuity with anti-VEGF therapy are worth the burden of this prolonged intensive observation.”
Follow-up of babies treated with bevacizumab (Avastin, Genentech) for ROP show that the optical components and macula take on the characteristics of a full-term child. In contrast, eyes of laser-treated babies retain the features of a preterm child, Dr. Mintz-Hittner said.
Dr. Mintz-Hittner is the Alfred W. Lasher III Professor of Ophthalmology and Visual Science, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center, Houston.
“Eyes treated with anti-VEGF therapy have continued development of the anterior chamber, and compared with their laser-treated counterparts, have a flatter cornea, deeper anterior chamber, and thinner lens,” Dr. Mintz-Hittner explained. “Therefore, children treated with anti-VEGF for ROP have less high myopia and a decreased risk of angle-closure glaucoma.”
In addition, the peripheral retina remains intact and retinal vascular development continues following anti-VEGF therapy, which results in an increased peripheral visual field. Foveal and macula development continues as well, so children treated with anti-VEGF therapy have better visual acuity.