With the rising incidence of retinopathy of prematurity (ROP) as neonatal care improves, the use of anti-vascular endothelial growth factor (anti-VEGF) drugs has surged among infants at risk of this condition. Recent findings reveal significant differences among three commonly used anti-VEGF drugs—ranibizumab, bevacizumab, and aflibercept—in their effects on the retinal maturation process and the likelihood of developing persistent avascular retina (PAR).
A study conducted by researchers at the University of Health Sciences Antalya Training and Research Hospital focused on children aged 4 to 8 who were treated for ROP during their neonatal period. The researchers aimed to assess retinal vascularization and the prevalence of PAR caused by varying anti-VEGF therapies, highlighting the importance of this knowledge for determining long-term outcomes.
Retinopathy of prematurity occurs when abnormal retinal vascularization compromises the development of the retina, often due to factors associated with preterm birth and low birth weight. While laser therapy is the gold standard for treating ROP, it can permanently halt vascular growth, resulting in visual field loss. Conversely, anti-VEGF therapy has emerged as a more ‘preservation-focused’ approach, allowing the potential for normal vascularization to occur.
During the study, which ran from January 2016 to December 2020, the researchers used advanced imaging techniques, including the Optos confocal laser ophthalmoscope, to capture ultra-wide field retinal images of participants, along with evaluations of visual acuity and intraocular pressure. The study examined 196 eyes from 100 patients, categorizing them based on their treatment history and ROP status.
The data revealed stark differences among the treatment groups. Of the children who underwent anti-VEGF therapy, 45 out of 108 eyes exhibited PAR, translating to 41.7% prevalence compared to only 3.2% and 17.4% observed in the non-ROP group and untreated ROP group, respectively. Aflibercept was found to be associated with the highest rate of PAR at 68.2% among treated eyes, indicating significant concerns about the complications stemming from its usage.
"The prevalence of PAR differs between anti-VEGF drugs," stated the authors of the article. "Patients treated with aflibercept have a higher risk of late complications and should be followed closely." This highlights the urgent need for enhanced monitoring protocols for infants treated with this specific drug.
The study aimed not just to highlight the prevalence rates but also to address the importance of long-term outcomes for those treated with various anti-VEGF drugs. The researchers emphasized the necessity of thorough follow-up for those receiving Afistan anti-VEGF treatments due to the observed higher risk of complications later.
Current treatment practices follow strategies based on balancing the risks of abnormal vascularization against the complications of more aggressive treatments like laser therapy. The findings from this study suggest careful consideration is necessary when determining treatment paths for premature infants, with precautions needing to be taken as the usage of anti-VEGF therapies become more widespread.
Despite the advantages provided by anti-VEGF drugs, their long-lasting impacts on retinal health must be weighed carefully. The findings indicate both the successes and potential pitfalls of anti-VEGF therapies, particularly underlining aflibercept's troubling association with late complications related to PAR.
"With the widespread use of anti-VEGF drugs, their long-term effects are becoming more apparent," the authors warned, calling for future research to explore the underlying mechanisms of these drugs and their long-term ramifications. Such studies could provide insights for optimizing treatments and ensuring the best outcomes for this vulnerable population.
Overall, with findings indicating significant differences among the three drugs, the study urges continued investigation and careful long-term monitoring of outcomes for patients treated for ROP, especially as incidence rates and treatment options evolve alongside advancements in neonatal care.