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Semin Perinatol. 2019 Oct;43(6):360-366. doi: 10.1053/j.semperi.2019.05.009. Epub 2019 May 11.

Pharmacologic interventions for the prevention and treatment of retinopathy of prematurity.

Author information

1
Department of Pediatrics, Division of Neonsatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States; Department of Ophthalmology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States; State University of New York Eye Institute, New York, NY 10075, United States. Electronic address: jaranda@downstate.edu.
2
State University of New York Eye Institute, New York, NY 10075, United States; Department of Pharmaceutical Sciences, State University of New York in Buffalo, Buffalo, NY, United States.
3
Department of Pediatrics, Division of Neonsatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States.
4
Department of Pediatrics, Division of Neonsatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States; Department of Ophthalmology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States; State University of New York Eye Institute, New York, NY 10075, United States.

Abstract

Retinopathy of Prematurity (ROP) is a preventable neovascular retinal disease with a lifetime impact on vision and ocular morbidities. Retinal vessel immaturity and oxygen therapy, influenced or modulated by several risk factors including oxidative stress, intermittent hypoxia and desaturations, inflammation, infection, malnutrition, retinal growth factor deficiencies or excesses, and others are determinant factors of pathologic retinal angiogenesis and ROP. These factors are pharmacologic targets for prevention and/or rescue therapy. These drugs, include intravitreal anti-vascular endothelial growth factor drugs, erythropoietin, ocular propranolol, caffeine, antioxidants, insulin-like growth factor-I, and omega 3 poly-unsaturated fatty acids, and are promising therapies to prevent ROP, but require further studies. Topical ocular non-steroidal anti-inflammatory drugs (NSAIDs) target inflammatory cascade but the best, safest, and most effective ocular NSAID and formulation remain to be developed. Timing of drug intervention appears critical. Moreover, the complex interactions of the various pathophysiologic mechanisms resulting in aberrant angiogenesis thence ROP strongly suggest that drug combinations and synergisms may be required for effective prevention of ROP and a lifetime of blindness.

KEYWORDS:

AntiVEGF; Antioxidants; Bevacizumab; Caffeine; IGF-1; Intermittent hypoxia; NSAIDs; Oxidative stress; Propranalol; Ranibizumab; Retinopathy of prematurity; Vascular endothelial growth factor

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