A Systematic Review and Meta-Analysis on the Safety of Vascular Endothelial Growth Factor (VEGF) Inhibitors for the Treatment of Retinopathy of Prematurity.

INTRODUCTION: Laser photocoagulation is the current gold standard treatment for proliferative retinopathy of prematurity (ROP). However, it permanently reduces the visual field and might induce myopia. Vascular endothelial growth factor (VEGF) inhibitors for the treatment of ROP may enable continuing vascularization of the retina, potentially allowing the preservation of the visual field. However, for their use in infants concern remains. This meta-analysis explores the safety of VEGF inhibitors. METHODS: The Ovid Interface was used to perform a systematic review of the literature in the databases PubMed, EMBASE and the Cochrane Library. RESULTS: This meta-analysis included 24 original reports (including 1.457 eyes) on VEGF inhibitor treatment for ROP. The trials were solely observational except for one randomized and two case-control studies. We estimated a 6-month risk of retreatment per eye of 2.8%, and a 6-month risk of ocular complication without the need of retreatment of 1.6% per eye. Systemic complications were only reported as isolated incidents. DISCUSSION: VEGF inhibitors seem to be associated with low recurrence rates and ocular complication rates. They may have the benefit of potentially allowing the preservation of visual field and lower rates of myopia. Due to the lack of data, the risk of systemic side effects cannot be assessed.

Circadian macular volume changes in the healthy human choroid.

PURPOSE: To investigate a potential circadian fluctuation of the choroidal volume in healthy adults by enhanced depth imaging (EDI) via spectral-domain optical coherence tomography (SD OCT). DESIGN: Prospective observational case series. METHODS: Thirty healthy eyes of 15 healthy subjects with a median age of 26 years (range 22-55) underwent EDI SD OCT scans for macular choroidal volume measurement every 3 hours within a 24-hour period at a single tertiary center. The mean ocular perfusion pressure was calculated for each eye at each of the 8 time points as 2/3(mean arterial pressure-intraocular pressure [IOP]). The circadian fluctuation of the macular choroidal volume as well as the association with axial length, mean ocular perfusion pressure, or IOP was assessed using a linear mixed model. RESULTS: Macular choroidal volume showed a significant circadian fluctuation (P < .05) and was lowest at midday (mean ± SD, 10.14 ± 2.62 mm(3)) and highest at 3 AM (mean ± SD, 10.66 ± 2.70 mm(3)). Of all factors tested, only mean ocular perfusion pressure showed a significant association with macular choroidal volume fluctuation (P = .016). CONCLUSIONS: Macular choroidal volume shows a significant circadian pattern with higher values at night and lower values during the day in young adults. Besides time, mean ocular perfusion pressure is significantly associated with this fluctuation.

Role of the vitamin K epoxide reductase complex subunit 1 (VKORC1) -1639G>A gene polymorphism in patients with retinal vein occlusion.

PURPOSE OF THE STUDY: Retinal vein occlusion (RVO) is a major vision-threatening disease. Vitamin K epoxide reductase recycles reduced vitamin K, which is essential for the gamma carboxylation of clotting factors II, VII, IX, X and proteins C and S. Recently, the vitamin K epoxide reductase complex subunit 1 (VKORC1) -1639G>A (rs9923231) polymorphism has been reported as a novel risk factor for RVO in a Turkish population. The present study was set to confirm or to refute this association in a larger cohort of patients with RVO. MATERIALS AND METHODS: The present case-control study comprised 285 patients with central RVO, 401 patients with branch RVO and 333 control subjects. Genotypes of the VKORC1 -1639G>A polymorphism were determined by 5' exonuclease assay (TaqMan). RESULTS: No significant differences in either genotype distributions or allele frequencies of the vitamin K epoxide reductase complex subunit 1 -1639G>A polymorphism were found between patients and control subjects (p > 0.05). In a logistic regression analysis neither branch nor central RVO was predicted by the vitamin K epoxide reductase complex subunit 1 -1639G>A genotypes, but by arterial hypertension, ever-smoking status and in case of central RVO additionally by diabetes mellitus. CONCLUSIONS: Our data suggest that the vitamin K epoxide reductase complex subunit 1 -1639G>A gene polymorphism is unlikely a major risk factor for patients with either central or branch RVO.