Retinopathy of Prematurity; therapy modalities,BIUMS,BY DR JOOBIN KHADAMY

1. 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

2. MODALITIES
• Ablative therapy
• Cryo-
• Laser
• Anti-VEGF
• Vitrectomy

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

4. ADVANTAGES OF LASER THERAPY
• High success rate (up to 90%)
• Defined follow up period (50 weeks)
• Prevent lifelong Retinal detachment
https://www.aao.org/eyenet/article/current-rop-therapies-how-laser-antivegf-compare
PERIPHERALLASER.Wide-angleviewoffundusafter
laserphotocoagulationforROPwithplusdisease.

5. 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
https://www.aao.org/eyenet/article/current-rop-therapies-how-laser-antivegf-compare
PERIPHERALLASER.Wide-angleviewoffundusafter
laserphotocoagulationforROPwithplusdisease.

6. 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?!
https://www.aao.org/eyenet/article/current-rop-therapies-how-laser-antivegf-compare
BEVACIZUMABSTEPS.(2A)Areaisthoroughlypreppedwithpovidone-iodine.(2B)
Determininginjectionsitewithcaliper.(2C)Preparingforinjection.

7. 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;
https://www.aao.org/eyenet/article/current-rop-therapies-how-laser-antivegf-compare
BEVACIZUMABSTEPS.(2A)Areaisthoroughlypreppedwithpovidone-iodine.(2B)
Determininginjectionsitewithcaliper.(2C)Preparingforinjection.

8. 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

9. FURTHER STUDIES
• First line therapy choice (Zone I : Anti VEGF; zone II:?)
• Combination
• Dose
• Time
• Follow up
https://www.aao.org/eyenet/article/current-rop-therapies-how-laser-antivegf-compare

10. 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 laser
Mutlu 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.

11. 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-compare
Mutlu 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.

12. THANK YOU FOR ATTENTION