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Intravitreal anti-VEGF therapy as an adjunct to laser photocoagulation for severe aggressive posterior retinopathy of prematurity Terapia anti-VEGF intravitrea como complemento a la fotocoagulacion por laser en la retinopatia posterior agresiva severa del prematuro

ABSTRACT: Purpose The aim of the study was to evaluate the role of anti-VEGF therapy as an adjunct to laser ablation therapy in severe aggressive posterior retinopaty of prematurity (AP-ROP). Methods Medical records of premature infants with a primary diagnosis of AP-ROP treated with 0.625 mg/0.025 ml intravitreal bevacizumab (IVB) in addition to standard laser photocoagulation as a salvage therapy or primarily combined with laser in a university clinic were reviewed, retrospectively. The anatomical results and complications were evaluated after treatment. Results 15 eyes of 9 patients with a mean gestational age of 28.3 weeks (range, 26–31 w) and mean birth weight of 1090 g (range, 860–1330 g) were included in the study. They all had Zone 1 or posterior Zone 2 plus disease staging between severe 3 and 4a. Twelve eyes were treatment naive at the beginning. The mean follow-up was 19.5 ± 11.8 months (range, 11–40 months). The disease regressed totally in 6 eyes (40%), stayed stable as stage 4a in 1 eye (6.7%), progressed to and stabilized at stage 4a in 3 eyes (20%) and progressed to stage 5 in 3 eyes (20%) within 7–10 days. Two eyes (13.3%) developed hypotony and cataract. Conclusion The association of IVB and laser ablation might decrease the progression rate in severe AP-ROP. Prompt regression of iris neovascularization encourages its use in cases with pupillary rigidity to allow for laser treatment. When used as a salvage therapy it may not change the overall result dramatically.

SUBMITTER: Ozdek S

PROVIDER: S-EPMC3880506 | biostudies-literature | 2012 Sep

REPOSITORIES: biostudies-literature

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Project description:ObjectiveCompare the efficacy of ranibizumab, aflibercept, laser, and sham in the first-line treatment of diabetic macular edema (DME) to inform technology assessments such as those conducted by the UK National Institute for Health and Care Excellence (NICE).Data sourcesMEDLINE, Embase, Cochrane Library, congress abstracts, ClinicalTrials.gov registry and Novartis data on file.Inclusion criteriaStudies reporting 6- or 12-month results of randomized controlled trials (RCTs) evaluating at least two of ranibizumab 0.5 mg pro re nata, aflibercept 2.0 mg bi-monthly, laser photocoagulation or sham. Study quality was assessed based on likelihood of bias in selection, attrition, detection and performance.Outcome measureImprovement in best-corrected visual acuity (BCVA) measured as the proportion of patients gaining ≥10 letters on the Early Treatment Diabetic Retinopathy Study scale. The outcome was chosen following acceptance by NICE of a Markov model with 10-letter health states in the assessment of ranibizumab for DME.Meta-analysisBayesian network meta-analyses with fixed and random effects adjusted for differences in baseline BCVA or central retinal thickness.ResultsThe analysis included 1,978 patients from eight RCTs. The random effects model adjusting for baseline BCVA was the best model based on total residual. The efficacy of ranibizumab was numerically, but not statistically, superior to aflibercept (odds ratio [OR] 1.59; 95% credible interval [CrI], 0.61-5.37). Ranibizumab and aflibercept were statistically superior to laser monotherapy with ORs of 5.50 (2.73-13.16) and 3.45 (1.62-6.84) respectively. The probability that ranibizumab is the most efficacious treatment was 73% compared with 14% for aflibercept, 12% for ranibizumab plus laser, and 0% for laser.LimitationsThree of the eight RCTs included are not yet published. The models did not adjust for all potential effect modifiers.ConclusionRanibizumab was non-significantly superior to aflibercept and both anti-VEGF therapies had statistically superior efficacy to laser.

Project description:PurposeTo establish a comprehensive treatment strategy and evaluate the efficacy of combination of anti-vascular endothelial growth factor (VEGF) injection, pars plana vitrectomy (PPV), endoscopic pan-retinal photocoagulation (PRP), and endoscopic cyclophotocoagulation (ECP) surgery for neovascular glaucoma (NVG) patients.MethodsThis retrospective study included 30 patients (30 eyes) who were suffering from NVG and treated with PPV & PRP & ECP (ECP group, 16 eyes), or Ahmed glaucoma valve implantation (Ahmed group, 14 eyes). The intraocular pressure (IOP), number of postoperative anti-glaucoma medications, best-corrected visual acuity (BCVA), successful rate of surgery, and postoperative complications were recorded and statistically analyzed at the time points of preoperative, 1-day, 1-month, 3-months, 6-months, and 12-months after operation.ResultsAn obvious reduction in IOP and number of postoperative anti-glaucoma medications were observed in both the ECP group and Ahmed group after operation (P < 0.05), and the ECP group showed a significantly lower IOP compared to the Ahmed group at the 6-months (P = 0.014) and 12-months (P = 0.047) postoperative time points, while there was no significant difference of medication number between the two groups except for 1-day after surgery. The BCVA showed no marked difference between the two groups preoperatively and postoperatively (P > 0.05), while it was significantly improved in ECP group at 3-months (P = 0.001), 6-months (P = 0.004), and 12-months (P = 0.010) time points comparing with preoperative BCVA. The surgical success rates in ECP group were also slightly higher than Ahmed group. And the complications after operation showed no marked differences.ConclusionsThe comprehensive treatment of PPV, endoscopic PRP, and ECP surgery for NVG patients after anti-VEGF injection can control IOP effectively and be friendly to patients' BCVA without obvious serious complications throughout a 12-months follow-up period.

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Intravitreal anti-VEGF therapy as an adjunct to laser photocoagulation for severe aggressive posterior retinopathy of prematurity Terapia anti-VEGF intravitrea como complemento a la fotocoagulacion por laser en la retinopatia posterior agresiva severa del prematuro

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