Reactivation of retinopathy of prematurity: current aspects and unsolved problems—a review

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Abstract

Due to advances in modern neonatology in the care of extremely premature infants in economically developed countries, including Russia, retinopathy of prematurity (ROP) and its consequences continue to represent a significant proportion of ophthalmic pathologies of early childhood. Thus, as the number of extremely immature premature infants increases, so does the number of severe, rapidly progressing forms of ROP localized to the central fundus (zone I ROP and aggressive posterior ROP) that are resistant to laser coagulation. In recent decades, intravitreal injection of anti-VEGF agents (VEGF, vascular endothelial growth factor) has been a primary treatment modality for ROP.

The purpose of this review is to systematically review studies on ROP reactivation. Risk factors for ROP reactivation, its frequency, and its dependence on the choice of treatment strategy are discussed. The effectiveness of all commonly used anti-VEGF agents worldwide is analyzed comparatively in relation to the development of signs of ROP reactivation, including dosage- and duration-dependent effects.

An important part of this review discusses the time course of ROP reactivation, since clear criteria for differentiating this timing have not yet been established. We also address long-term retinal changes in the cicatricial phase of the disease, which are clinically similar to those seen in active retinopathy and involve tractional-exudative changes at the borders of persistent avascular zones, as well as approaches to treatment, including preventive measures.

The review demonstrates an association between an increased frequency of ROP reactivation following anti-VEGF therapy, underscoring the need to develop new approaches to long-term follow-up of these patients. The prolongation of possible reactivation periods due to repeated anti-VEGF injections to achieve ROP regression should proportionally extend the duration of follow-up for these patients, especially when avascular zones persist in the retina.

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About the authors

Serg V. Lesovoy

Russian Children’s Clinical Hospital; International Scientific and Practical Center for Tissue Proliferation; The Russian National Research Medical University named after N.I. Pirogov

Author for correspondence.
Email: sergforester1@mail.ru
ORCID iD: 0009-0006-9249-5013
SPIN-code: 6033-6471

MD

Russian Federation, Moscow; Moscow; Moscow

Olga S. Krivovyaz

Russian Children’s Clinical Hospital; The Russian National Research Medical University named after N.I. Pirogov

Email: olga-eye@mail.ru
ORCID iD: 0009-0001-3768-6283
SPIN-code: 6115-0644

MD

Russian Federation, Moscow; Moscow

Yuliya D. Kuznetsova

Russian Children’s Clinical Hospital; International Scientific and Practical Center for Tissue Proliferation

Email: kuznecovay2011@mail.ru
ORCID iD: 0000-0003-4985-7198
SPIN-code: 9251-6263

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow; Moscow

Ekaterina A. Bogomolova

The Russian National Research Medical University named after N.I. Pirogov

Email: bogomolova.ekaterina.2000@gmail.com
ORCID iD: 0000-0003-1764-6599
SPIN-code: 4593-4110

MD

Russian Federation, Moscow

Jean M. Salmasi

The Russian National Research Medical University named after N.I. Pirogov

Email: profjms@yandex.ru
ORCID iD: 0000-0001-8524-0019
SPIN-code: 9350-1266

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Larisa M. Balashova

International Scientific and Practical Center for Tissue Proliferation

Email: blm1962@yandex.ru
ORCID iD: 0000-0001-9349-7092
SPIN-code: 8314-7638

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

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