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Medication

Medication Summary

Intravitreal aflibercept (Eylea), a VEGF inhibitor, gained FDA approval in February 2023 as the first pharmacologic treatment for preterm infants with retinopathy of prematurity (ROP).

If a patient has prethreshold ROP, some centers try to maintain normal serum levels of vitamin E. Vitamin E use was evaluated in a meta-analysis, and levels should be maintained within the reference range in patients at high risk for severe ROP.

Class Summary

Vascular endothelial growth factor-A (VEGF-A) and placental growth factor (PlGF) are members of the VEGF family of angiogenic factors that can act as mitogenic, chemotactic, and vascular permeability factors for endothelial cells.

VEGF receptor 1 (VEGFR-1) and VEGFR-2, present on the surface of endothelial cells. PlGF binds only to VEGFR-1, which is also present on the surface of leukocytes.

Activation of these receptors by VEGF-A can result in neovascularization and vascular permeability.

Aflibercept intravitreal (Eylea)

View full drug information

Aflibercept acts as a soluble decoy receptor that binds VEGF-A and PlGF, and thereby can inhibit the binding and activation of these related VEGF receptors. It is indicated for prematurity of retinopathy.

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Hwang CK, Hubbard GB, Hutchinson AK, Lambert SR. Outcomes after intravitreal bevacizumab versus laser photocoagulation for retinopathy of prematurity: a 5-year retrospective analysis. Ophthalmology. 2015 May. 122(5):1008-15. [QxMD MEDLINE Link]. [Full Text].
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Media Gallery

Retinopathy of Prematurity. Stage I retinopathy of prematurity.
Retinopathy of Prematurity. Scheme of retina of right eye (RE) and left eye (LE) showing zone borders and clock hours used to describe location and extent of retinopathy of prematurity.
Retinopathy of Prematurity. Zone I retinopathy of prematurity.
Retinopathy of Prematurity. Zone II retinopathy of prematurity.
Retinopathy of Prematurity. Zone III retinopathy of prematurity.
Retinopathy of Prematurity. Stage II retinopathy of prematurity.
Retinopathy of Prematurity. Stage III retinopathy of prematurity.
Retinopathy of Prematurity. Mild extraretinal fibrovascular proliferation.
Retinopathy of Prematurity. Moderate extraretinal fibrovascular proliferation.
Retinopathy of Prematurity. Severe extraretinal fibrovascular proliferation.
Retinopathy of Prematurity. A comparison between attached and detached retina.
Retinopathy of Prematurity. Retinopathy of prematurity (ROP) threshold, according to the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) Cooperative Group.
Retinopathy of Prematurity. Treatment guidelines, according to the Early Treatment for Retinopathy of Prematurity (ET-ROP) study.
Retinopathy of Prematurity. Laser photocoagulation. RPE = retinal pigment epithelium.
Retinopathy of Prematurity. Cryotherapy probe application.

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Author

Siva Subramanian, MD, FAAP Emeritus Chief of Neonatal-Perinatal Medicine, Medstar Georgetown University Hospital; Professor Emeritus of Pediatrics and Obstetrics, Senior Ethicist, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center

Siva Subramanian, MD, FAAP is a member of the following medical societies: American Pediatric Society, American Association for the Advancement of Science, American College of Nutrition, American Pediatric Society, American Society for Parenteral and Enteral Nutrition, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Melissa D Kern, MD Owner and Ophthalmologist in Pediatric and Adolescent Ophthalmology and Adult Strabismus, Arlington-Loudon Pediatric Ophthalmology; Chief of Surgery (Ophthalmology), Virginia Hospital Center

Melissa D Kern, MD is a member of the following medical societies: Northern Virginia Academy of Ophthalmology

Disclosure: Nothing to disclose.

William F Deegan, III, MD Associate Clinical Professor of Ophthalmology, Georgetown University School of Medicine; Attending Surgeon, Spectrum Retina and Ocular Oncology, Virginia Hospital Center Health System

William F Deegan, III, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, Massachusetts Medical Society, Washington Academy of Eye Physicians and Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Arun K Pramanik, MD, MBBS Professor of Pediatrics, Louisiana State University Health Sciences Center

Arun K Pramanik, MD, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, National Perinatal Association, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Santina A Zanelli, MD Associate Professor, Department of Pediatrics, Division of Neonatology, University of Virginia Health System

Santina A Zanelli, MD is a member of the following medical societies: American Academy of Pediatrics, American Epilepsy Society, Society for Neuroscience, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Oussama Itani, MD, FAAP, FACN Clinical Associate Professor of Pediatrics and Human Development, Michigan State University; Medical Director, Department of Neonatology, Borgess Medical Center

Oussama Itani, MD, FAAP, FACN is a member of the following medical societies: American Academy of Pediatrics, American Association for Physician Leadership, American Heart Association, American College of Nutrition

Disclosure: Nothing to disclose.

Monisha Bahri, MBBS, MD Attending Physician, Department of Neonatalogy, Washington Hospital Center

Monisha Bahri, MBBS, MD is a member of the following medical societies: American Academy of Pediatrics, Medical Council of India, Indian Academy of Pediatrics

Disclosure: Nothing to disclose.

Gonzalo (Vike) Vicente, MD, FAAP Consulting Ophthalmologist, Eye Doctors of Washington

Gonzalo (Vike) Vicente, MD, FAAP is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, American Medical Association

Disclosure: Nothing to disclose.

Retinopathy of Prematurity Medication

Medication Summary

Ophthalmics, VEGF Inhibitors

Class Summary

Aflibercept intravitreal (Eylea)

Aflibercept intravitreal (Eylea)

Gestational Age at Birth (wk)	Chronologic Age (wk)	Postmenstrual Age (wk)
22^*	9	31
23^*	8	31
24	7	31
25	6	31
26	5	31
27	4	31
28	4	32
29	4	33
30	4	34
31 (if necessary)	4	35
32 (if necessary)	4	36

Retinopathy of Prematurity Medication

Medication Summary

Ophthalmics, VEGF Inhibitors

Class Summary

Aflibercept intravitreal (Eylea)

Aflibercept intravitreal (Eylea)

References

Tables

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