Antivascular endothelial growth factor for retinopathy of prematurity.

PURPOSE OF REVIEW: This review will discuss a potentially more effective treatment for retinopathy of prematurity (ROP) with fewer acute and long-term complications. Avastin (bevacizumab) therapy is a promising anti-vascular endothelial growth factor (anti-VEGF) administered directly into the vitreous. RECENT
FINDINGS: Recent reports detail the use of Avastin alone, and in combination with light amplification by stimulated emission of radiation (LASER) therapy and vitrectomy, for ROP stages 3, 4, and 5. Currently, one clinical trial is studying Avastin alone for acute vision-threatening ROP stage 3 in zone I and posterior zone II without LASER therapy. Another clinical trial is investigating Avastin following LASER therapy for recurrent ROP stages 4 and 5.
SUMMARY: Treatment for ROP has evolved from later, more destructive (cryotherapy) to earlier, less destructive (LASER therapy) peripheral retinal ablation. If evidence-based data supports early findings, the use of Avastin may be recommended without the need for ablative LASER therapy and before retinal detachment develops. Avastin will be especially useful for ROP stage 3 cases with hemorrhage decreasing retinal visualization, rigid pupils, intravitreal neovascularization with early or developing (minimal) fibrous membranes, or aggressive posterior retinopathy of prematurity (AP-ROP). These cases all continue to have poor outcomes with LASER therapy.