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Retinopathy of Prematurity (ROP) affects premature newborns, and it can cause childhood blindness and visual impairment if untreated. The understanding of the pathogenetic role of Vascular Endothelial Growth Factor (VEGF) has led to development of therapeutic strategies such as intravitreal anti-VEGF drugs. We reported drug efficacy and ROP recurrence rates, extrapolated from the reviewed studies. Association of Pegabtanib and laser photocoagulation confers efficacy in the regression of ROP stage 3 plus in zone I / II in 89.7% of treated eyes, reducing the recurrence rate to 14.6% compared to 50% of laser therapy alone. Irrespective of the dose, Ranibizumab demonstrated average efficacy greater than 75% on regression of active disease with the highest rates of the dose of 0.1 mg (92.5%). The recurrence, on the other hand, is the highest among this new anti-VEGF agents and is around an average of 41.5%, which records the highest values in the case of Aggressive Posterior Rop (APROP). Aflibercept at a dose of 1 mg demonstrated average efficacy of about 81.9% of treated infants, analyzing significantly fewer studies than Ranibizumab. The recurrence rate stands at an average of 28.9%, especially in the later forms of ROP. Using a dose of 0.25 mg of Conbercept, the disease regression rate is currently on average 83%, with an average recurrence rate of 15.24%, the peak of which was observed in cases of ROP in zone I. Further studies are needed to prove safety at long term, because,at the moment, only short-term data are available.

Purpose: To evaluate the efficacy and the rate of side effects of the pegylated aptamer pegaptanib in the treatment of patients with choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and a history of previous arterial thromboembolic events (ATEs). Methods: Twenty-three eyes of 23 patients with subfoveal CNV due to AMD and cerebrovascular accidents (n = 12) and myocardial infarction (n = 11) in the previous 6 months received intravitreal pegaptanib 0.3 mg according to a pro re nata regimen and were followed for 12 months. The paired Student t test was used to evaluate mean changes in best-corrected visual acuity (BCVA; primary outcome measure) and central foveal thickness (CFT). Results: The mean patient age was 71.5 ± 4.6 years; there were 14 women and 9 men. The CNV was type 1, 2, and 3 in 18, 3, and 2 eyes, respectively. The mean BCVA improved from 0.67 ± 0.23 logMAR at baseline to 0.52 ± 0.31 logMAR at the end of 12-month follow-up (p = 0.044). Thirty-five percent of patients achieved ≥3 Early Treatment Diabetic Retinopathy Study lines improvement at 12 months. Mean CFT at baseline (381 ± 111 µm) decreased to 304 ± 82 µm at 12 months (p = 0.008). Patients received a mean of 4.3 ± 1.3 (range 3-7) injections. No systemic or ocular side effects occurred; no patient experienced further ATEs. Conclusions: Intravitreal pegaptanib can be considered a viable treatment option for patients with AMD-related CNV who are at high risk of ATEs.

Purpose: Acute retinal necrosis (ARN) is a panuveitis syndrome that may lead to severe complications such as cystoid macular edema (CME). There is no consensus about the best treatment. We report one case of CME secondary to ARN managed with intravitreal aflibercept. Case report: A 41-year-old woman with a history of successfully treated varicella-zoster virus-associated ARN developed an epiretinal membrane (ERM) and underwent pars plana vitrectomy, ERM removal, inner limiting membrane peel, and lensectomy. After surgery, the retinal architecture improved and the visual acuity returned to 20/20. Six months later, she developed nontractional CME, which was treated monthly with triple-dose intravitreal aflibercept (2 mg). She gained 3 lines of vision and CME resolution was achieved. Discussion: Cystoid macular edema is a late complication of ARN that may affect vision. Some off-label therapies have been reported to be useful in CME secondary to ARN, including pegaptanib and interferon-α-2. Since interferon-α-2a is not currently available for ophthalmic use in Spain, aflibercept was the first choice. This soluble protein blocks the placental growth factor and all isoforms of vascular endothelial growth factor (VEGF); its half-life is prolonged and its affinity to VEGF-A is more than 100-fold greater than bevacizumab, pegaptanib, or ranibizumab. After each injection, macular thickness decreased consistently and visual acuity improved 3 lines after the treatment. Conclusions: Intravitreal aflibercept is effective in the management of acute nontractional CME secondary to ARN.

To evaluate the effect of 2 vascular endothelial growth factor (VEGF) isoforms (121 and 165) and 2 anti-VEGF compounds (ranibizumab and pegaptanib sodium) on the permeability of human retinal pigment epithelium (RPE) cells in vitro. The RPE permeability was assessed on ARPE19 cells grown onto inserts of polytetrafluoroethylene previously treated with ammonia gas plasma. Paracellular permeability to ions was measured by mean of transepithelial electrical resistance (TEER). Permeability to non-ionic molecules was gathered by the amount of fluorescein dextran (FD) passing across the monolayer within 2 hours. Only VEGF165 applied at the apical side of the monolayer induced a statistically significant decrease of TEER (p0.001). No changes in TEER were observed when pegaptanib sodium or ranibizumab were apically administered together with VEGF165. Both VEGF isoforms significantly increased permeability to 4 kDa dextran (p0.01). Apical administration of ranibizumab or pegaptanib sodium as well as coadministration of pegaptanib sodium with VEGF121 or VEGF165 induced a statistically significant increase of permeability to 4 kDa FD. Both VEGF isoforms and anti-VEGF compounds exert an effect on human RPE permeability in vitro.

To investigate efficacy of intravitreal injection of pegaptanib and laser photocoagulation for treatment of stage 3+ retinopathy of prematurity (ROP) affecting zone I and posterior zone II, and to compare the results in terms of regression, development of peripheral retinal vessels, and final structural outcome with conventional laser photocoagulation or combined with cryotherapy. Methods. In a prospective comparative study, 152 eyes with zone I, II posterior ROP 3+ (76 premature rabies), from 2009 to 2011, were included. Patients were randomly assigned to receive intravitreal pegaptanib (Macugen 0.3 mg = 0.02 mL, Pfizer) with conventional diode laser photocoagulation in group 1 (68 eyes of 34 infants) or only laser therapy combined with cryotherapy in group 2 (84 eyes of 42 infants), bilaterally. The primary outcome of treatment success was defined as absence of recurrence of stage 3+ ROP. The mean follow-up after treatment was 19.3 months in group 1 and 21.5 months in group 2. Results. Final favorable anatomic outcome and stable regression of ROP at last control examination was noted in 89.7% of eyes in group 1 and 60.8 % of eyes in group 2. Regression of plus disease and peripheral retinal vessels development appeared significantly more rapidly in group 1. No recurrence of neovascularization (stage 3+ ROP) was identified in 85.4% of patients in group 1 and 50% of patients in group 2. Conclusions. Results of this study support the administration of intravitreal pegaptanib as useful therapy in the management of stage 3+ ROP.

Purpose.Anti-vascular endothelial growth factor (VEGF) therapy is a first-line treatment for age-related macular degeneration (AMD) but frequent visits and injections can be a burden for patients. The purpose of this study is to estimate the remission rate and tolerability of anti-VEGF therapy for AMD in a clinical setting.Methods.We investigated 90 eyes of 87 patients with AMD who underwent anti-VEGF therapy and were followed for more than 6 months. Ranibizumab and pegaptanib were used as anti-VEGF agents. Initial therapy was any of the following: a single injection, 3 consecutive monthly injections, or combination therapy with verteporfin. Additional injections were given as-needed during follow-up. An injection-free period greater than 6 months at the final observation was regarded as cessation; the reason for cessation was studied for each patient. Clinical characteristics were compared between patents with and without cessation.Results.The mean follow-up period was 12.8 months. Mean logMAR before and 6 months after the treatment was 0.89 and 0.83, respectively. Cessation was noted in 32 eyes of 31 patients (35.6%). Remission was achieved in 13 (40.6%) of these eyes. The other cases either did not wish to undergo further treatment or dropped out. Poor baseline visual acuity (VA) was associated with cessation.Conclusions.With current anti-VEGF therapy, remission was achieved in a limited number of AMD cases. The high frequency of voluntary cessation warrants consideration of an alternative treatment and/or supportive care for those with poor baseline VA.

Purpose Posterior hyaloid adherences play a role in the pathogenesis of diabetic macular edema (DME). Intravitreal antivascular endothelial growth factor (VEGF) drugs are presently being used to treat DME. The authors report one case of incomplete posterior hyaloid detachment (PHD) following intravitreal pegaptanib to treat DME. This case shows a combined mechanism of DME resolution by anti VEGF and PHD. Methods Prospective, interventional, single case report. One male patient with bilateral DME was treated by intravitreal pegaptanib in his right eye every 6 weeks for 6 months (five injections) and followed for 42 months. Results Central macular thickness decreased from 511 to 376 microm at month 4 in the treated eye and remained within 10% of this value during follow-up. The posterior hyaloid became taut and partially detached after the third injection and was almost completely detached 1 year later. Visual acuity remained unchanged in both eyes during follow-up. Conclusions PHD may play an important role in cases where macular thickness is successfully reduced or better acuity is achieved after intravitreal injections.

PurPose. Both intravitreal pegaptanib with laser therapy and intravitreal bevacizumab monotherapy have been found to be more efficacious than laser therapy alone in prospective, randomized, controlled clinical trials. results. The use of pegaptanib with laser therapy was efficacious in 91.2% compared with 69.0% in controls. The use of bevacizumab monotherapy was efficacious in 95.7% compared with 78.1% in controls. ConClusions. The use of anti–vascular endothelial growth factor therapy for retinopathy of prematurity has been shown to be efficacious, without toxicity reported to date; however, the best drug and dose which allows greatest efficacy with fewest recurrences and without toxicity must be determined.