title: Time to consider a new treatment protocol for aggressive posterior retinopathy of prematurity?
abstract: OBJECTIVE
  To discuss treatment modalities for aggressive posterior retinopathy of prematurity (AP-ROP).
  
  
  METHODS
  The medical charts of all infants with AP-ROP at Uppsala University Hospital, Sweden, during a 2-year period (2009 and 2010) were reviewed. Eight infants (16 eyes) with a mean gestational age of 23.8 weeks and a mean birth weight of 592 g were treated with laser and/or intravitreal injections of bevacizumab (0.4 and 0.625 mg). RetCam photography was used to document the retinal appearance before and after treatment.
  
  
  RESULTS
  All infants (16 eyes) had AP-ROP in zone I. Mean time at initial treatment was 34 weeks postmenstrual age. Two eyes (one infant) were only treated with laser, and six eyes (three infants) were treated with laser therapy or cryopexy and, because of lack of regression, with bevacizumab as salvage therapy. Eight eyes (four infants) were treated with a first-line bevacizumab injection and four of these eyes (two infants) with additional laser ablation for continued disease progression in zone II. Macular dragging occurred in one eye of one infant primarily treated with laser.
  
  
  CONCLUSIONS
  Given the high complication rate of the extensive laser treatment for zone I ROP, it is worth considering anti-vascular endothelial growth factor treatment as an alternative therapy. Further knowledge concerning side effects and long-term ocular and systemic outcome is warranted before this drug becomes general clinical practice.
authors.affiliation: Department of Neuroscience, University of Uppsala, Sweden.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Spandau
authors.forename: Zoran
authors.initials: Z
authors.lastname: Tomic
authors.forename: Uwe
authors.initials: U
authors.lastname: Ewald
authors.forename: Eva
authors.initials: E
authors.lastname: Larsson
authors.forename: Hanna
authors.initials: H
authors.lastname: Akerblom
authors.forename: Gerd
authors.initials: G
authors.lastname: Holmström
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D003131:Combined Modality Therapy; D003452:Cryosurgery; D005260:Female; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D017075:Laser Coagulation; D008297:Male; D010781:Photography; D015861:Retinal Neovascularization / Q000473:pathology / Q000628:therapy*; D012178:Retinopathy of Prematurity / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab