Re: Freedman et al: Low- and very low-dose bevacizumab for retinopathy of prematurity: reactivations, additional treatments, and 12-month outcomes (Ophthalmology. 2022;129:1120–1128)

Asensio-Sánchez, Víctor Manuel

doi:10.1016/j.ophtha.2022.12.016

Cited by 5 publications

(9 citation statements)

References 3 publications

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“…The optimal dosage for anti-VEGF agents remains poorly understood. Some studies have reported that a lower dosage of anti-VEGF can achieve similar efficacy of the conventional dose . From our practice, we suggest using a 0.25 mg/0.025 mL dose of ranibizumab for children younger than 2 years, in line with the dosage for treating retinopathy of prematurity.…”

Section: Methodsmentioning

confidence: 91%

Intra-Anterior Chamber Injection of Ranibizumab in Advanced Pediatric Vitreoretinal Diseases

Zhang,

Liu,

Chen

et al. 2024

JAMA Ophthalmol

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ImportanceAnti–vascular endothelial growth factor (VEGF) treatment through intravitreal or subretinal administrations has been proven effective for VEGF-driven pediatric vitreoretinal diseases but are not feasible for advanced cases, such as shallow traction retinal detachments or peripheral circumferential retinal detachments which adhere to the lens. Intra-anterior chamber injection (IAcI) of anti-VEGF may be a viable alternative in such cases but needs evaluation.ObjectiveTo investigate the effects and safety of IAcI of anti-VEGF to treat VEGF-driven pediatric vitreoretinal diseases.Design, Setting, and ParticipantsThis was a retrospective observational case series study conducted at Xinhua Hospital, affiliated with Shanghai Jiao Tong University School of Medicine in China. The study included 14 eyes of 13 children diagnosed with vitreoretinal disease exhibiting elevated vascular activity between January and August 2023.InterventionIAcI with ranibizumab.Main Outcomes and MeasuresRetinal vascular abnormalities, vitreous hemorrhage resolution, and complications 1 month and 3 months after injection.ResultsOf 13 patients included in this study, 12 were male. The mean age was 4.6 years (range, 1 month to 9 years). Six patients were diagnosed with familial exudative vitreoretinopathy, 4 with morning glory syndrome, 1 with retinopathy of prematurity, and 2 with chronic retinal detachments of unknown causes. At 1-month postoperative follow-up, vascular activity had decreased in 14 of 14 eyes. At 3-month follow-up, vascular activity had resolved in 7 of 14 eyes, persisted in 6 of 14 eyes, and reactivated in 1 of 14 eyes. On final observation, no complications were reported.Conclusions and RelevanceThese findings support the possibility of treatment using IAcI with ranibizumab to decrease retinal vascular abnormalities in familial exudative vitreoretinopathy or retinopathy of prematurity or related conditions, but further studies are needed to understand more precise benefits and risks. This approach might be considered in cases where intravitreal or subretinal injection are not feasible, recognizing the limitations of these findings and that longer-term outcomes still need to be monitored.

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Section: Methodsmentioning

confidence: 91%

Intra-Anterior Chamber Injection of Ranibizumab in Advanced Pediatric Vitreoretinal Diseases

Zhang,

Liu,

Chen

et al. 2024

JAMA Ophthalmol

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“… 18 In addition to the patient factors, the type of anti-VEGF (IVR > IVB) and lower injected doses may also increase the risk of recurrence (without compromising the initial response). 14 21 …”

Section: R Esultsmentioning

confidence: 99%

“…The rate of reactivation was not related to the dosage, but it occurred sooner with very low-dose IVB. 21 …”

Section: R Esultsmentioning

confidence: 99%

An update on anti-vascular endothelial growth factor treatment for retinopathy of prematurity

Sadeghi,

Nowroozzadeh,

Shahriari-Garaee

et al. 2023

J Curr Ophthalmol

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“…However, this may be significantly more than required to neutralise VEGF in the vitreous. Further studies looking at lower doses of Bevacizumab ranging from 0.16 to 0.004 mg have shown promising outcomes [ 59 , 60 ], although there is a likelihood of reactivation occurring sooner with lower doses [ 61 ].…”

Section: Introductionmentioning

confidence: 99%

“…Reactivation of ROP following intravitreal anti-VEGF injection may also be seen more in more posterior aggressive diseases or in those injected at a younger post-menstrual age [ 75 ]. Very low-dose bevacizumab for treatment of ROP, ranging from 0.002 to 0.016 mg, is also associated with earlier reactivations with a mean of 76.4 days to reactivation compared to low-dose bevacizumab, ranging from 0.031 to 0.25 mg, with a mean of 85.7 days to reactivation [ 61 ].…”

Section: Introductionmentioning

confidence: 99%

Retinopathy of prematurity: from oxygen management to molecular manipulation

Woods,

Biswas

2023

Mol Cell Pediatr

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Introduction Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the premature retina with the potential to progress to extraretinal neovascularisation. This review serves as an introduction to retinopathy of prematurity (ROP), outlining key parts of ROP pathophysiology, diagnosis and treatment. ROP is traditionally diagnosed by indirect ophthalmoscopy and classified using anatomical zones, stages of disease, and the presence or absence of “plus disease” (dilation and tortuosity of the major retinal arterioles and venules). ROP has a bi-phasic pathophysiology: initial hyperoxia causes reduced retinal vascularisation, followed by pathological vaso-proliferation resulting from subsequent hypoxia and driven by vascular endothelial growth factor (VEGF). Advancements in management This review summarises previous trials to establish optimum oxygen exposure levels in newborns and more recently the development of anti-VEGF agents locally delivered to block pathological neovascularisation, which is technically easier to administer and less destructive than laser treatment. Future directions There remains an ongoing concern regarding the potential unwanted systemic effects of intravitreally administered anti-VEGF on the overall development of the premature baby. Ongoing dosing studies may lessen these fears by identifying the minimally effective dose required to block extraretinal neovascularisation.

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Re: Freedman et al: Low- and very low-dose bevacizumab for retinopathy of prematurity: reactivations, additional treatments, and 12-month outcomes (Ophthalmology. 2022;129:1120–1128)

Cited by 5 publications

References 3 publications

Intra-Anterior Chamber Injection of Ranibizumab in Advanced Pediatric Vitreoretinal Diseases

Intra-Anterior Chamber Injection of Ranibizumab in Advanced Pediatric Vitreoretinal Diseases

An update on anti-vascular endothelial growth factor treatment for retinopathy of prematurity

Retinopathy of prematurity: from oxygen management to molecular manipulation

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