Retinopathy of Prematurity, Pain Management, BIUMS, Dr Joobin Khadamy, 1st feb 2018 It review current available therapies and future of therapy in management of retinopathy of prematurity.

1. THERAPY MODALITIES
RETINOPATHY OF
PREMATURITY
ROP Conference; Birjand University of Medical science (BIUMS)
Joobin Khadamy MD
1/Feb/2018

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)?
• Human milk
• 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. PROPHYLAXIS THERAPY?!
• Anti-inflamtory drugs
• Lactoferrin (Lonnerdal, 2009) Yes
• Pentoxifylline (Pammi and Haque, 2015) No!
• Corticosteroids (Halliday et al., 2009) Yes
• Caffeine (Schmidt et al., 2007) Yes
Chan-Ling, T., Gole, G.A., Quinn, G.E., Adamson, S.J., Darlow, B.A., Pathophysiology, screening and
treatment of ROP: A multi-disciplinary perspective, Progress in Retinal and Eye Research (2017), doi:
10.1016/j.preteyeres.2017.09.002.

13. THANK YOU FOR ATTENTION