Prospects for Treatment of Pediatric Vitreoretinal Diseases with Vascular Endothelial Growth Factor Inhibition

Abstract

While angiogenesis inhibitors are already widely used to treat retinal disease in adults, only limited reports are currently available for the use of anti-VEGF in pediatric vitreoretinal diseases such as retinopathy of prematurity, Coats' disease, familial exudative vitreoretinopathy and retinopathy of incontinentia pigmenti. The limited trials of anti-VEGF therapy for pediatric vitreoretinal diseases are promising, although more extensive controlled trials will be needed to confirm their safety and efficacy. This paper will examine the current evidence for use of anti-VEGF therapy in a number of pediatric vitreoretinal disorders and describe a case of anti-VEGF therapy in retinopathy of incontinentia pigmenti.

Anatomical and functional outcomes following vitrectomy for advanced familial exudative vitreoretinopathy: a single surgeon's experience

“…The use of intravitreal anti-VEGF agents to reduce the neovascular and exudative features in FEVR and other paediatric vitreoretinal diseases has been reviewed 18. Anti-VEGF therapy reduces retinal exudation and stabilises fibrovascular proliferation.…”

Bevacizumab for Coats' disease with exudative retinal detachment and risk of vitreoretinal traction

“…Newer reports have indicated probable role of somatic mutation in the NDP gene in the pathogenesis of Coats' disease 3. Vascular endothelial growth factor (VEGF) has been identified as a key regulator in angiogenesis and vascular permeability 4. He and co-workers quantified the level of VEGF in four eyes with Coats' disease (mean 2394.5 pg/ml) and compared it with VEGF levels in five eyes with rhegmatogenous retinal detachment (mean 15.3 pg/ml).…”

“…Lin and co-workers reviewed the literature on use of VEGF inhibitors in paediatric vitreoretinal diseases including retinopathy of prematurity (ROP), familial exudative vitreoretinopathy (FEVR) and retinopathy of incontinentia pigmenti. They commented on the possible serious adverse effects, but noted that no adverse systemic or ocular side effects have been reported to date 4. Several case reports have demonstrated presumed clinical benefit of VEGF inhibitors for Coats' disease.…”

Familial exudative vitreoretinopathy and related retinopathies

“…36,41,52,83,84 The use of intravitreal anti-VEGF injections to reduce the exudative and neovascular components of FEVR and other inherited retinal vasculopathies has been reviewed. 85 Anti-VEGF therapy reduces retinal exudation and neovascularisation in FEVR patients but the rapid resolution of exudation can stimulate worsening vitreoretinal traction that often requires surgery. This treatment may have a role as an adjunctive therapy before surgery.…”