ROP: Intravitreal Anti-VEGF Injections Risk Management Recommendations

Revised in 2022 based on ICROP3 definition changes*

AntiVEGF for ROP Risk Management Recommendations

The American Academy of Pediatrics Section on Ophthalmology revised its Policy Statement (PS) [1] on ROP screening late last year. We revised the ophthalmologist’s obligations for follow-up when an infant is treated with anti-VEGF medication so that they are consistent with the new PS. 2019 Changes are in orange.

Follow infants closely until at least 65 weeks postmenstrual age (PMA).

At 65 weeks PMA, may end screening if either of these endpoints has been reached: 1) Full vascularization in close proximity to the ora serrata for 360° OR 2) The avascular retina has been successfully treated with laser (e.g., no skip areas).

Use professional judgment on continued monitoring in the following circumstances if no treatment endpoint has been reached at 65 weeks PMA: 1) Low-grade disease that is clearly and slowly improving, 2) Stage 1 disease that is unchanged for 2 months, 3) No disease, no ROP, but incomplete vascularization, or 4) Infant has a DNR order.

[1] Fierson WM. “Screening Examination of Premature Infants for Retinopathy of Prematurity.” Policy Statement (PS) issued by the American Academy of Pediatrics (AAP) Section on Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), and the American Association of Certified Orthoptists. Originally issued in 1997 and updated in 2001, 2005, 2006, and 2018; current version published in Pediatrics (Volume 142, Number 6, 2018, at http://pediatrics.aappublications.org/content/early/2018/11/21/peds.2018-3061.

Laser consent form: http://www.omic.com/rop-laser-surgery/

Anti-VEGF consent form: http://www.omic.com/rop-anti-vegf-injection/

ROP Safety Net materials: https://www.omic.com/rop-safety-net/

*Chang MF, Quinn GE, Fielder AR, Wu WC, Zhao P, Zin A, et al. International Classification of Retinopathy of Prematurity, Third Edition. Ophthalmology. 2021;128(10):E51-E68. Available at: https://doi.org/10.1016/j.ophtha.2021.05.031 (Accessed: 3/10/22)

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