Image via WikipediaAn interesting read from the web this morning from the NEJM.Premature, low birth weight babies face a minefield of issues when brought into the world. One of most serious issues is the propensity for retinal blood vessels to grow amuck in response to erratic biochemical signals; these vessels can bleed and scar, leading to retinopathy of prematurity (ROP) — a major cause of childhood blindness in the developed and developing worlds.
The NEJM asks this question, and answers it in part:
So why not directly inhibit VEGF? Bevacizumab is a humanized monoclonal antibody that does just that. Soon after it was approved to arrest new blood supplies to colon cancer metastases in 2004, doctors began using the inexpensive, easily administered drug off-label to treat a neovascular condition similar to ROP: age-related macular degeneration. Case series have suggested that it works for ROP, but now we have more definitive proof.
In a prospective multi-center trial reported in NEJM this week, researchers from the University of Texas Health Science Center at Houston randomized 150 infants with posterior, stage 3+ ROP in zones 1 and 2 to receive either the standard confluent laser therapy (CLT) or an intravitreal injection of bevacizumab (IVB) in each eye. Stage 3+, defined by prominent new blood vessels growing between the vascular and avascular regions of the eye (the + indicates the vessels are twisted), may be the optimal time for treatment—after VEGF has promoted normal vascularization and before the vessels have formed fibrous bands that would permanently disrupt the retina. The zone refers to the concentric region of retina affected (zone 1 disease includes the optic nerve and is the hardest to treat). The researchers' primary goal in this federally sponsored study was to prevent recurrence of ROP in one or both eyes before 54 weeks postmenstrual age.
It's a compelling read for those parents, family members, and folks touched by a child with ROP.
