Introduction 
Laser photocoagulation is the current gold standard treatment for proliferative retinopathy of prematurity (ROP). However, it permanently reduces the visual field and might induce myopia. Vascular endothelial growth factor (VEGF) inhibitors for the treatment of ROP may enable continuing vascularization of the retina, potentially allowing the preservation of the visual field. However, for their use in infants concern remains. This meta-analysis explores the safety of VEGF inhibitors.


Methods 
The Ovid Interface was used to perform a systematic review of the literature in the databases PubMed, EMBASE and the Cochrane Library.


Results 
This meta-analysis included 24 original reports (including 1.457 eyes) on VEGF inhibitor treatment for ROP. The trials were solely observational except for one randomized and two case-control studies. We estimated a 6-month risk of retreatment per eye of 2.8%, and a 6-month risk of ocular complication without the need of retreatment of 1.6% per eye. Systemic complications were only reported as isolated incidents.


Discussion 
VEGF inhibitors seem to be associated with low recurrence rates and ocular complication rates. They may have the benefit of potentially allowing the preservation of visual field and lower rates of myopia. Due to the lack of data, the risk of systemic side effects cannot be assessed.

/pdf/a-systematic-review-and-meta-analysis-on-the-safety-of-3dlrezpe21.pdf

A Systematic Review and Meta-Analysis on the Safety of Vascular Endothelial Growth Factor (VEGF) Inhibitors for the Treatment of Retinopathy of Prematurity

The use of intravitreal vascular endothelial growth factor (VEGF) inhibitor medications has widened considerably to include indications affecting females of reproductive age. Our patient was inadvertently exposed to bevacizumab within the first trimester when placental growth and fetal organogenesis take place and patient suffered pregnancy loss. There is insufficient information to suggest that such use is safe, nor is there definitive evidence to suggest that it causes harm. We advise that ophthalmologists discuss pregnancy with women of childbearing age undergoing intraocular anti-VEGF injections and in pregnant woman counselling is needed to explain the potential risks and benefits.

Intravitreal vascular endothelial growth factor (VEGF) inhibitor injection in unrecognised early pregnancy

The treatment of neovascular age-related macular degeneration (AMD) and other pathologic ocular conditions that overexpress the vascular endothelial growth factor (VEGF) has been revolutionized in the last decade by the introduction of intravitreal agents that target the VEGF pathway. Since treatment trials are designed primarily to assess the prevention of vision loss caused by ocular conditions, they are inadequate for detecting rare, but potentially serious, systemic side effects. The aim of this article is to present what the ophthalmologist needs to know about systemic complications from anti-VEGF therapy and review the likelihood that these side effects occur in the context of small, but often-repeated, intravitreal doses of these potent biological medications. Preferred practice patterns need to be developed that weigh the ability of these medications to mitigate potentially blinding conditions, while at the same time minimizing the risk of adverse outcomes in specific patient populations that possess multiple and often interrelated medical comorbidities.

Complications of subspecialty ophthalmic care: systemic complications from the intravitreal administration of agents that target the vascular endothelial growth factor pathway.

Purpose To study the success rate of LASER as a primary modality of treatment in aggressive posterior retinopathy of prematurity (APROP) cases. Methods This is a prospective case series of 56 eyes of 28 preterm babies (males = 21) with APROP who underwent laser therapy. Babies were divided into groups on the basis of gestational age (GA), birth weight (BW), and postmenstrual age (PMA) at which treatment was performed. GA (in weeks): 28 (n = 7), 28-30 (n = 11), > 30 (n = 10). BW (in grams): 1000 (n = 8), 1000-1200 (n = 10), > 1200 (n = 10). PMA (in weeks): 32 (n = 6), 32-34 (n = 18), > 34 (n = 4). Success was calculated as complete regression of disease without need for any other modality of treatment such as anti-vascular endothelial growth factor (anti-VEGF) or pars plana vitrectomy. Results The overall success rate was 94.64% (53/56). Two babies who needed additional modality of treatment were 28 weeks of GA (one eye) and 28-30 weeks (two eyes). One baby (one eye) was 1000 gm and the other (two eyes) was > 1200 gm, while PMA at which additional treatment was needed was 30 weeks in one baby (one eye) and 33 weeks in the other (two eyes). Conclusion In this era of anti-VEGF treatment, even in cases of APROP, LASER should still be considered as a primary modality of treatment, as it is a one-time treatment without the concern of systemic side effects and recurrent/persistent avascular zones.

/pdf/aggressive-posterior-retinopathy-of-prematurity-aprop-laser-4zpgh9lbef.pdf

Aggressive Posterior Retinopathy of Prematurity (APROP): LASER as the Primary Modality of Treatment

An 88-year-old woman on long-term intravitreal bevacizumab presented with acute gastrointestinal hemorrhage. She was stabilized and underwent nonrevealing upper endoscopy. She continued to require intermittent blood transfusions, and resulting computed tomography of the abdomen revealed an aortoduodenal fistula. The patient was undergoing treatment for her macular degeneration with intravitreal bevacizumab, an angiogenesis inhibitor frequently used to treat solid organ malignancies. Systemic administration has been associated with serious adverse events, including gastrointestinal hemorrhage, perforation, and fistula formation. Intravitreal bevacizumab has been used off-label to treat macular degeneration, but data on the safety of this therapy are limited. Given her lack of other risk factors, the authors postulate a potential association between intravitreal bevacizumab and aortoduodenal fistula formation in this patient.

Aortoduodenal fistula in a patient on intravitreal bevacizumab injections: a case report.

Purpose: This study compared serum vascular endothelial growth factor (VEGF) concentration between patients given the bilateral and unilateral intravitreal injections of bevacizumab. Methods: In a prospective manner, serum VEGF levels in treatment-naive patients with age-related macular degeneration who underwent bilateral or unilateral intravitreal injections of bevacizumab were investigated. After informed consent, peripheral blood was collected from in patients who underwent bilateral or unilateral intravitreal injection of bevacizumab before and 1 month after the injection. Serum VEGF levels were measured by enzyme-linked immunosorbent assay after centrifugation. In addition, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) before and 1 month after the injection were compared between each group. Results: Twenty patients received bilateral injections (40 eyes) and 20 patients received unilateral injections. The VEGF concentrations (pg/mL) before the bilateral injection were 235.75 ± 183.16 and 252.53 ± 233.52 for the unilateral injection. They were significantly reduced to 153.88 ± 113.26 and 189.42 ± 251.72 after 1 month, respectively (p = 0.037 and 0.019), which are showing no significant difference between the two groups (p = 0.771). And there were no significant intergroup difference in pre- and postoperative BCVA and CRT. Conclusions: The bilateral simultaneous intravitreal injection of bevacizumab did not differ greatly from unilateral intravitreal injection in the influence on serum VEGF levels and the therapeutic outcome.

/pdf/serum-concentration-of-vascular-endothelial-growth-factor-1kc7wk3haw.pdf

Serum Concentration of Vascular Endothelial Growth Factor after Bilateral Intravitreal Injection of Bevacizumab

Cutaneous Malignant Peripheral Nerve Sheath Tumor – A case report and literature review

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Serum Concentration of Vascular Endothelial Growth Factor after Bilateral Intravitreal Injection of Bevacizumab

Cutaneous Malignant Peripheral Nerve Sheath Tumor – A case report and literature review