Efficiency in treatment of retinopathy of prematurity using anti-VEGF therapy with bevacizumab

    Abstract

    Efficiency in treatment of retinopathy of prematurity using anti-VEGF therapy with bevacizumab

    E.Е. Sidorenko , A.O. Nazarenko , E.I. Sidorenko , I.V. Sukhanova , D.V. Migel , E.G. Mironova , N.M. Roselio Kecada

    The N.I. Pirogov Russian National Research Medical University, Moscow
The V. F. Voino-Yasenetsky Scientific Practical Center of Specialized Medical Care for Children. The Health Department of Moscow, Moscow

    Purpose. To study the efficiency of intravitreal injections of the VEGF inhibitor bevacizumab in case of retinopathy of prematurity.

    Material and methods. Intravitreal bevacizumab injections were performed in 220 patients with retinopathy of prematurity. An analysis of efficacy in the treatment using bevacizumab was studied in 412 eyes (220 patients). All children underwent an assessment of the anterior segment of the eye using a manual slit lamp, the retinal pediatric camera RetCam3, ophthalmoscopy, spectral optical coherence tomography, electrophysiological examination. The intraocular pressure and perfusion in the central retinal artery were under control. The children were under a constant supervision of neonatologists, intensive care physicians and ophthalmologists. Pre- and post-operatively the children were in a specialized neonatal unit with intensive care beds.

    Results.There were detected no complications intraoperatively. The efficiency of the treatment was 93.5%. A stabilization of retinopathy of prematurity (ROP) was revealed on average 3 days after the intravitreal injection of bevacizumab. The rigidity of pupil was neutralized within 7 days after the bevacizumab intravitreal injection in 92 children with an active ROP form. The stabilization of pathological neovascularization and the beginning of disease regression in the form of a stabilization of vascular and exudative components during the next 7 days after the intravitreal injection of bevacizumab occurred in all cases. A complete vascularization of zone III of the retina happened at 65 weeks of the post-conceptual age.

    Conclusion. Bevacizumab, injected intravitreally, has the following advantages over the laser photocoagulation of retina: a short time of anesthesia for a child, an absence of scarring damages of retina in the form of peripheral chorioretinal dystrophy, no need for a specialized operating room, a possibility to carry out it in case of a rigid pupil, with turbid optical media and in patients with contra-indications to long-term anesthesia.

    Key words: vascular endothelial growth factor inhibitors, bevacizumab (Avastin), retinopathy of prematurity.