http://www.evrs.eu/medias/2006/congress/Anti-VEGF-Therapy-for-Pediatric-Retinopathies:-Which-Case-Is-the-Right-Case.swf

Kimberly A. Drenser, MD (Royal Oak, CA), Michael T. Trese, MD (Royal Oak, MI), Antonio Capone, MD (Royal Oak, MI)

PURPOSE:

To review the usefulness and the appropriate case selection of anti-VEGF agents for the treatment of vitreoretinopathies in the pediatric population.

METHODS:

Patients with either retinopathy of prematurity (ROP) or familial exudative vitreoretinopathy (FEVR) were considered for anti-VEGF treatment in combination with standard of care treatments. Babies at post-menstrual age of 34 weeks or less with ROP requiring laser or status-post laser with persistent Plus disease were considered for enrollment. Five patients received unilateral anti-VEGF injection and were evaluated prospectively. FEVR patients with persistent exudation threatening the macula despite laser treatment, cryotherapy, and/or steroid injection received anti-VEGF injection. Treated patients were evaluated retrospectively.

RESULTS:

Three of the 5 babies enrolled for treatment of ROP received Macugen injection at the time of the first laser treatment. Two of these babies had uneventful courses with no progression to retinal detachment in either eye. The third baby progressed to bilateral retinal detachment. However, the anti-VEGF treated eye progressed more slowly and responded better to surgical intervention. Two babies were treated with Macugen for persistent Plus despite laser intervention. Both babies demonstrated decreased vascular activity in the treated eyes first but also progressed to retinal detachment earlier. FEVR patients showed a dramatic decrease in exudation and subretinal fluid following injection with an anti-VEGF agent. All patients achieved improved vision as well. Three patients developed tractional retinal detachments due to increased vitreoretinal fibrosis. These patients underwent vitrectomy and also achieved improved final vision.

CONCLUSION:

Pediatric viteroretinopathies with a common pathophysiology of increased vascular activity, abnormal vasculature and exudation have improved outcomes with the addition of anti-VEGF treatment. The key determinant for success appears to be the time of intervention. Early blockade of VEGF, before a significant rise in TGF-b concentration occurs, is vital for effective management.