title: Retinal microvascular plasticity in a premature neonate.
abstract: Dilation and abnormal tortuosity of retinal vessels are the hallmarks of severe retinopathy of prematurity (ROP) in premature infants. The stages of ROP are defined by vessel appearance at the interface between the vascular and avascular retinal areas. Deregulated signaling pathways involving hypoxia-inducible factors such as vascular endothelial growth factor (VEGF) are involved in the pathogenesis of ROP. VEGF-antagonists are increasingly being used as 'off-label medication' to treat this condition, with some success. We present Baby SM (female), who was born prematurely at 24 weeks gestation in a tertiary neonatal intensive care unit, and with a birth weight of 640 g. On screening at 35 weeks postmenstrual age (PMA), she was noted to have ROP, which became severe by 37 weeks PMA. She received one dose of intravitreal VEGF antagonist (Bevacizumab), resulting in a decrease in vessel tortuosity and dilation. However, repeat imaging at 4 weeks showed a re-emergence of vessel tortuosity. We believe the observed changes demonstrate an inherent retinal microvascular plasticity in premature neonates. With improved survival of extremely premature neonates and the availability of retinal imaging technology, we are now able to observe this plasticity.
authors.affiliation: 1Department of Neonatology,The Townsville Hospital,Townsville, QLD,Australia.
authors.forename: Y
authors.initials: Y
authors.lastname: Kandasamy
authors.affiliation: 4Department of Optometry and Vision Science,The University of Melbourne,Melbourne, VIC,Australia.
authors.forename: L
authors.initials: L
authors.lastname: Hartley
authors.affiliation: 2Mothers and Babies Research Centre,Hunter Medical Research Institute,John Hunter Hospital,The University of Newcastle,Callaghan, NSW,Australia.
authors.forename: R
authors.initials: R
authors.lastname: Smith
mesh_terms: D020533:Angiogenesis Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D000068258:Bevacizumab / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D055806:Microvessels / Q000000981:diagnostic imaging* / Q000187:drug effects; D011247:Pregnancy; D047928:Premature Birth / Q000000981:diagnostic imaging* / Q000188:drug therapy; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors; D012160:Retina / Q000000981:diagnostic imaging / Q000187:drug effects; D012171:Retinal Vessels / Q000000981:diagnostic imaging* / Q000187:drug effects; D012178:Retinopathy of Prematurity / Q000000981:diagnostic imaging* / Q000188:drug therapy
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor
keywords: neonate; plasticity; premature; preterm; retinal microvascular