Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Chang Gung University, College of Medicine, Taoyuan, Taiwan.
Asia Pac J Ophthalmol (Phila). 2018 May-Jun;7(3):145-151. doi: 10.22608/APO.201837. Epub 2018 Apr 9.
Vascular endothelial growth factor (VEGF) is an important mediator of the pathological neovascularization and vascular permeability of the eye. The increasing use of intravitreal therapies targeting VEGF has revolutionized the treatment of pediatric vitreoretinal diseases. In retinopathy of prematurity (ROP), the role of VEGF in pathogenesis has been well recognized and the use of anti-VEGF treatment in phase 2 ROP has demonstrated promising results, particularly in severe cases of posterior disease. This has made VEGF an established target in the treatment of pediatric retinal diseases known to have abnormal vascular activity. However, questions remain about late systemic and neurodevelopmental effects after anti-VEGF therapy for children because intravitreal injection of anti-VEGF may result in systemic circulation of anti-VEGF agent and a corresponding suppression of systemic VEGF. We do not currently know whether the short-term suppression of systemic VEGF affects long-term neurodevelopmental outcomes because VEGF is a vital supporting factor during neurodevelopment. This review article focuses on the evidence for the use of anti-VEGF treatment in certain pediatric ocular diseases, including ROP, Coats disease, and retinoblastoma. More extensive and prospective studies are warranted to further elucidate the role of anti-VEGF therapy in these diseases and illustrate how we can optimally use these agents in pediatric patients.
血管内皮生长因子（VEGF）是眼部病理性新生血管和血管通透性的重要介质。针对 VEGF 的眼内治疗的广泛应用彻底改变了儿科玻璃体视网膜疾病的治疗方法。在早产儿视网膜病变（ROP）中，VEGF 在发病机制中的作用已得到充分认识，抗 VEGF 治疗在 2 期 ROP 中的应用已显示出良好的效果，特别是在后部疾病的严重病例中。这使得 VEGF 成为治疗已知具有异常血管活性的儿科视网膜疾病的既定靶点。然而，由于眼内注射抗 VEGF 可能导致抗 VEGF 药物进入全身循环并相应抑制全身 VEGF，因此关于儿童接受抗 VEGF 治疗后的晚期全身和神经发育影响仍存在疑问。我们目前尚不清楚短期抑制全身 VEGF 是否会影响长期神经发育结局，因为 VEGF 是神经发育过程中的重要支持因素。本文重点介绍了抗 VEGF 治疗在某些儿科眼部疾病中的应用证据，包括 ROP、Coats 病和视网膜母细胞瘤。需要更广泛和前瞻性的研究来进一步阐明抗 VEGF 治疗在这些疾病中的作用，并说明如何在儿科患者中最佳使用这些药物。
