retinopathy of prematurity, therapy modalities,biums, joobin khadamy

T H E R A P Y M O D A L I T I E S

RETINOPATHY OF PREMATURITY

ROP Conference; Birjand University of Medical science (BIUMS)Joobin Khadamy MD

11/March/2017

MODALITIES

• Ablative therapy

• Cryo-

• Laser

• Anti-VEGF

• Vitrectomy

STANDARD CARE

Laser TherapyVs.

Anti-VEGF

https://www.aao.org/eyenet/article/current-rop-therapies-how-laser-antivegf-compare

ADVANTAGES OF LASER THERAPY

• High success rate (up to 90%)

• Defined follow up period (50 weeks)

• Prevent lifelong Retinal detachment


PERI

PHER

AL L

ASER

. Wid

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view

of

fund

us a

fter l

aser

pho

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agul

atio

n fo

r ROP

with

pl

us d

iseas

e.

DISADVANTAGES OF LASER THERAPY

• Setting and surgeon comfort(OR vs. NICU)• Time to perform: hours/ Response: weeks• Needs for general anesthesia • Cardiopulmonary events• Developmental side effects

• Structural results ( ETDRS> 30% RD zone I)• Myopia (40 to 80%)• Glaucoma ( Anterior segment arrest)• Visual field damage• Cataract


PERI

PHER

AL L

ASER

. Wid

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gle

view

of

fund

us a

fter l

aser

pho

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agul

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n fo

r ROP

with

pl

us d

iseas

e.

ADVANTAGES OF ANTI-VEGF

• Easy to perform in OR or NICU

• No Needs for general anesthesia

• Time perform: minutes/ Response: immidiate

• Structural results

retina and vessel reach to ora, but how functional?!

• Myopia (40 %)

• No Anterior segment arrest?

• Better visual acuity and fields?!


BEVA

CIZU

MAB

STE

PS. (

2A) A

rea

is th

orou

ghly

pre

pped

with

pov

idon

e-io

dine

. (2B

) Det

erm

inin

g in

ject

ion

site

with

cal

iper

. (2C

) Pre

parin

g fo

r in

ject

ion.

DISADVANTAGES OF ANTI-VEGF

• Slow down retinal vascularization

• No defined Follow up

• Recurrence up to 20 % even in 70 weeks!

• Developmental issues

• Safety ( BEAT ROP> 4/5 pulmonary death)

• Dosage

• Endophthalmitis; Cataract;


BEVA

CIZU

MAB

STE

PS. (

2A) A

rea

is th

orou

ghly

pre

pped

with

pov

idon

e-io

dine

. (2B

) Det

erm

inin

g in

ject

ion

site

with

cal

iper

. (2C

) Pre

parin

g fo

r in

ject

ion.

TREATMENT EFFECT. (3A) Pretreatment temporal fundus photo of left eye of infant at age 2.5 months (born at 24 weeks gestational age)

with zone I aggressive posterior ROP. (3B) FA at 13 months after intravitreal bevacizumab monotherapy shows further vascularization of

the peripheral retina. Black arrows indicate identical retinal points; yellow arrows show the temporal extent of retinal vessels; white arrows

show the extent of the retinal vessels before treatment.https://www.aao.org/eyenet/article/current-rop-therapies-how-laser-antivegf-compare

FURTHER STUDIES

• First line therapy choice (Zone I : Anti VEGF; zone II:?)

• Combination

• Dose

• Time

• Follow up


NOVELTIES!

• Propranolol (PROP-ROP)failed!

• Gene Therapy (viral RNA; animal studies)human!

• Granulocyte colony-stimulating factor (GCSF)

• increase levels of IGF-1 > decreased need for laserMutlu FM, Sarici SU. Treatment of retinopathy of prematurity: a review of conventional and promising

new therapeutic options. International Journal of Ophthalmology. 2013;6(2):228-236. doi:10.3980/j.issn.2222-3959.2013.02.23.

PROPHYLAXIS THERAPY?!

• Inositol (by Dale Phelps, MD)?

• Omega-3, PUFA (by Dr. Smith)?

• IGF-I. (Dr. Yang /Dr. Smith)?

• Light before birth?

• Avoid Erythropoietin?

• Vitamin E (NEC/ Sepsis)?1 Rao S et al. Nature. 2013;494(7436):243-247.2 Yang MB et al. Ophthalmology. 2013;120(12):2706-2713.https://www.aao.org/eyenet/article/current-rop-therapies-how-laser-antivegf-compareMutlu FM, Sarici SU. Treatment of retinopathy of prematurity: a review of conventional and promising new therapeutic options. International Journal of Ophthalmology. 2013;6(2):228-236. doi:10.3980/j.issn.2222-3959.2013.02.23.



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retinopathy of prematurity, therapy modalities,biums, joobin khadamy

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