Hapsari Dini, Sitorus Rita S
From the Department of Ophthalmology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Asia Pac J Ophthalmol (Phila). 2014 Nov-Dec;3(6):368-78. doi: 10.1097/APO.0000000000000039.
This article is aimed to review and summarize the indications, outcomes and safety profiles regarding the use of intravitreal bevacizumab in patients with retinopathy of prematurity (ROP) as reported in previous studies with no intention to compare the efficacy between intravitreal bevacizumab and laser photocoagulation.Literature search was conducted in databases such as PubMed, Cochrane, Ovid, and Ophthalmology Advance using the terms "ROP," "antiangiogenic," "antivascular endothelial growth factor," "intravitreal bevacizumab," and "Avastin."Eight prospective studies of 278 eyes of ROP infants and 15 retrospective studies involving 385 eyes of ROP infants treated with intravitreal bevacizumab were found. Bevacizumab was used as monotherapy, adjunctive therapy, and/or combined therapy.The varied use of intravitreal bevacizumab in treating ROP and he limited number of landmark studies contribute to the difficulties in drawing a strong conclusion in this review. Intravitreal bevacizumab was more commonly injected in: (1) type 1 ROP zone I and/or posterior zone II; (2) aggressive posterior ROP with poor retinal visualization in which laser photocoagulation would be difficult to perform; and (3) stage 4 ROP before vitrectomy. All cases demonstrated regression of neovascular activity during a varied follow-up period (from 1 week to 1 month) after injection. However, recurrence may occur. Follow-up until 80 weeks of postmenstrual age is thus recommended. Acceleration of fibrous traction is the most common ocular adverse effect after injection, whereas the systemic adverse effect remains uncertain. Landmark studies of the efficacy of intravitreal bevacizumab injection in treating ROP are warranted.
本文旨在回顾和总结既往研究中报道的玻璃体内注射贝伐单抗治疗早产儿视网膜病变（ROP）的适应证、治疗效果和安全性，无意比较玻璃体内注射贝伐单抗与激光光凝治疗的疗效。通过在PubMed、Cochrane、Ovid和《眼科进展》等数据库中检索“ROP”“抗血管生成”“抗血管内皮生长因子”“玻璃体内注射贝伐单抗”和“阿瓦斯汀”等关键词，发现了8项关于278只ROP婴儿眼睛的前瞻性研究和15项关于385只接受玻璃体内注射贝伐单抗治疗的ROP婴儿眼睛的回顾性研究。贝伐单抗被用作单一疗法、辅助疗法和/或联合疗法。玻璃体内注射贝伐单抗在ROP治疗中的多种应用以及标志性研究数量有限，使得本综述难以得出强有力的结论。玻璃体内注射贝伐单抗更常用于：（1）1型ROP的I区和/或II区后部；（2）视网膜可视化差的侵袭性后部ROP，难以进行激光光凝治疗；（3）玻璃体切除术前的4期ROP。所有病例在注射后的不同随访期（从1周到1个月）均显示新生血管活动消退。然而，可能会复发。因此建议随访至月经后年龄80周。注射后最常见的眼部不良反应是纤维牵拉加速，而全身不良反应尚不确定。有必要开展关于玻璃体内注射贝伐单抗治疗ROP疗效的标志性研究。
