title: Role of cytokines and treatment algorithms in retinopathy of prematurity.
abstract: OBJECTIVE
  Currently, severe retinopathy of prematurity (ROP) is diagnosed by clinical evaluation and not a laboratory test. Laser is still considered standard care. However, anti-vascular endothelial growth factor (VEGF) agents are being used and there are questions whether and/or if to use them, what dose or type of agent should be considered and what agent may be most beneficial in specific cases. Also unclear are the effects of laser or anti-VEGF on severe ROP, refractive outcomes or infant development. This article reviews recent studies related to these questions and other trials for severe ROP.
  
  
  RESULTS
  Imaging studies identify biomarkers of risk (plus disease, stage 3 ROP, and ROP in zone I). Intravitreal bevacizumab or ranibizumab are reported effective in treating aggressive posterior ROP in small series. Recurrences and effects on myopia vary among studies. Use of anti-VEGF agents affects cytokines in the infant blood and reduces systemic VEGF for up to 2 months, raising potential safety concerns. The effects of treatment vary based on infant size and are not comparable. Evidence for most studies is not high.
  
  
  CONCLUSIONS
  Studies support experimental evidence that inhibiting VEGF reduces stage 3 ROP and peripheral avascular retina. Ongoing large-scale clinical trials may provide clarity for best treatments of severe ROP. Current guidelines hold for screening and treatment for type 1 ROP.
authors.affiliation: John A. Moran Eye Center, University of Utah, Salt Lake City Utah, USA.
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Hartnett
mesh_terms: D000465:Algorithms; D020533:Angiogenesis Inhibitors / Q000378:metabolism / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000627:therapeutic use; D016207:Cytokines / Q000502:physiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D058449:Intravitreal Injections; D000069579:Ranibizumab / Q000627:therapeutic use; D012178:Retinopathy of Prematurity / Q000175:diagnosis; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; D016207:Cytokines; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab