Intravitreal anti-VEGF therapy as an adjunct to laser photocoagulation for severe aggressive posterior retinopathy of prematurity

AbstractPurposeThe 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).MethodsMedical records of premature infants with a primary diagnosis of AP-ROP treated with 0.625mg/0.025ml 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.Results15 eyes of 9 patients with a mean gestational age of 28.3 weeks (range, 26–31w) and mean birth weight of 1090g (range, 860–1330g) 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.ConclusionThe 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

Strategy for the management of diabetic macular edema: the European Vitreo-Retinal Society macular edema study

Objective. To compare the efficacy of different therapies in the treatment of diabetic macular edema (DME). Design. Nonrandomized, multicenter clinical study. Participants. 86 retina specialists from 29 countries provided clinical information on 2,603 patients with macular edema including 870 patients with DME. Methods. Reported data included the type and number of treatment(s) performed, the pre-and posttreatment visual acuities, and other clinical findings.The results were analyzed by the French INSEE (National Institute of Statistics and Economic Studies). Main Outcome Measures. Mean change of visual acuity and mean number of treatments performed. Results.The change in visual acuity over time in response to each treatment was plotted in second order polynomial regression trend lines. Intravitreal triamcinolone monotherapy resulted in some improvement in vision. Treatmentwith threshold or subthreshold grid laser also resulted in minimal vision gain. Anti-VEGF therapy resulted in more significant visual improvement. Treatment with pars plana vitrectomy and internal limiting membrane (ILM) peeling alone resulted in an improvement in vision greater than that observed with anti-VEGF injection alone. In our DME study, treatment with vitrectomy and ILM peeling alone resulted in the better visual improvement compared to other therapies

The role of intraoperative bevacizumab for prevention of postoperative vitreous hemorrhage in diabetic vitreous hemorrhage

Purpose: To assess the effect of intravitreal bevacizumab (IVB) on the incidence of postoperative recurrent vitreous hemorrhage (VH) in eyes operated for diabetic VH when injected at the end of the surgery

Tachyphylaxis during ranibizumab treatment of exudative age-related macular degeneration.

Letter to the Edito