Dataset Information

A Systematic Review and Meta-Analysis on the Safety of Vascular Endothelial Growth Factor (VEGF) Inhibitors for the Treatment of Retinopathy of Prematurity.

ABSTRACT: Laser photocoagulation is the current gold standard treatment for proliferative retinopathy of prematurity (ROP). However, it permanently reduces the visual field and might induce myopia. Vascular endothelial growth factor (VEGF) inhibitors for the treatment of ROP may enable continuing vascularization of the retina, potentially allowing the preservation of the visual field. However, for their use in infants concern remains. This meta-analysis explores the safety of VEGF inhibitors.The Ovid Interface was used to perform a systematic review of the literature in the databases PubMed, EMBASE and the Cochrane Library.This meta-analysis included 24 original reports (including 1.457 eyes) on VEGF inhibitor treatment for ROP. The trials were solely observational except for one randomized and two case-control studies. We estimated a 6-month risk of retreatment per eye of 2.8%, and a 6-month risk of ocular complication without the need of retreatment of 1.6% per eye. Systemic complications were only reported as isolated incidents.VEGF inhibitors seem to be associated with low recurrence rates and ocular complication rates. They may have the benefit of potentially allowing the preservation of visual field and lower rates of myopia. Due to the lack of data, the risk of systemic side effects cannot be assessed.

SUBMITTER: Pertl L

PROVIDER: S-EPMC4470662 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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A Systematic Review and Meta-Analysis on the Safety of Vascular Endothelial Growth Factor (VEGF) Inhibitors for the Treatment of Retinopathy of Prematurity.

Pertl Laura L Steinwender Gernot G Mayer Christoph C Hausberger Silke S Pöschl Eva-Maria EM Wackernagel Werner W Wedrich Andreas A El-Shabrawi Yosuf Y Haas Anton A

PloS one 20150617 6

<h4>Introduction</h4>Laser photocoagulation is the current gold standard treatment for proliferative retinopathy of prematurity (ROP). However, it permanently reduces the visual field and might induce myopia. Vascular endothelial growth factor (VEGF) inhibitors for the treatment of ROP may enable continuing vascularization of the retina, potentially allowing the preservation of the visual field. However, for their use in infants concern remains. This meta-analysis explores the safety of VEGF inh ...[more]

PMID: 26083024

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Project description:OBJECTIVE:To determine the effects of oxygen fluctuations on pigment epithelial-derived factor (PEDF) and vascular endothelial growth factor (VEGF)/PEDF ratios in a relevant rat model of retinopathy of prematurity (ROP). METHODS:The expression of retinal PEDF mRNA and of VEGF and PEDF protein were determined using real-time polymerase chain reaction or enzyme-linked immunosorbent assays at different postnatal day ages for rat pups raised in room air (RA) or in a rat model mimicking ROP. Statistical outcomes were determined with factorial analyses of variance. Mean VEGF and PEDF protein levels were determined at different ages for rats in the ROP model and for RA-raised rats, and the ratio of VEGF/PEDF protein versus age was plotted. At postnatal day (P) 14, inner retinal plexus vascularization had extended to the ora serrata in pups raised in RA. In the ROP model, avascular retina persisted at P14 and intravitreous neovascularization developed at P18. Therefore, VEGF and PEDF expression was determined in the ROP model and in RA-raised rat pups at P14 and P18. RESULTS:Older age was associated with increased PEDF mRNA (p<0.001), PEDF protein (p=0.005), and VEGF protein (p=0.005), and VEGF protein (p<0.0001). Exposure to fluctuations of oxygen in the 50/10 oxygen-induced retinopathy model compared to RA was associated with increased PEDF mRNA (p=0.0185), PEDF protein (p<0.0001), or VEGF protein (p<0.0001). The VEGF/PEDF ratio favored angiogenic inhibition (<1.0) before but not on P14, when avascular retina persisted in the ROP model but not in RA. The VEGF/PEDF ratio favored angiogenesis (>1.0) at P14 and P 18 when intravitreous neovascularization occurred in the ROP model. CONCLUSIONS:Increased expression levels of VEGF and PEDF are associated with older postnatal day age or with exposure to fluctuations in oxygen in the 50/10 oxygen-induced retinopathy model compared to RA. PEDF protein more closely associates with avascular retinal features and neovascularization than does VEGF protein or the VEGF/PEDF in the ROP model. Although PEDF has been proposed as a potential treatment in ROP, interventional studies using PEDF in an ROP model to potentially reduce intravitreous neovascularization are required to determine timing, efficacy, and dose of PEDF.

Project description:OBJECTIVE:To investigate the relationship between vascular endothelial growth factor (VEGF) gene polymorphisms and Retinopathy of prematurity (ROP) development in preterm infants of China Han ethnic population. METHODS:VEGF gene promoter polymorphisms (-165C/T and -141A/C) were studied in 54 neonates with ROP but not requiring treatment (regressive ROP group), 48 neonates with ROP that requires cryotherapy/photocoagulation (severe ROP group), and in a control group of 62 preterm infants without ROP. Genotyping for VEGF gene promoter was performed by polymerase chain reaction (PCR) and gene sequencing. RESULTS:In this study, -165C/T genotype was found to be associated with severe ROP (P=0.012<0.05), but not with regressive ROP. For the dominant genetic model, subjects carrying the -165T allele had a decreased risk of ROP compared to those non-carrying the -165C allele in both regressive ROP regressive group and severe ROP group, and especially in severe ROP group (in regressive ROP group: OR=2.069, 95% CI=0.986-4.340; in severe ROP group: OR=3.677, 95% CI=1.339-10.099). For the allelic model, comparing the A allele to the C allele, the -165C/T site also showed a decreased risk of ROP in both regressive ROP group and severe ROP group (in regressive ROP group: OR=2.395, 95% CI=1.112-5.157; in severe ROP group: OR=4.258, 95% CI=1.518-11.945). In -141A/C genotypes and alleles were found not to be associated with severe ROP or regressive ROP. Linkage disequilibrium analysis revealed -165C/T and -141A/C were a strong linkage disequilibrium, and haplotype analysis revealed that T-165C-141 haplotype was associated with resistance to severe ROP but C-165A-141 haplotype was associated with risk to severe ROP. No statistically significant differences were observed in regressive ROP group. CONCLUSION:VEGF -165C/T SNP is associated with ROP especial in severe ROP. VEGF -141A/C SNP is not associated with ROP. T-165C-141 and C-165A-141 haplotypes may have a role in severe ROP.

Dataset Information

A Systematic Review and Meta-Analysis on the Safety of Vascular Endothelial Growth Factor (VEGF) Inhibitors for the Treatment of Retinopathy of Prematurity.

Publications

A Systematic Review and Meta-Analysis on the Safety of Vascular Endothelial Growth Factor (VEGF) Inhibitors for the Treatment of Retinopathy of Prematurity.

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