Unique Pathological and Physiological Angiogenesis of ROP in Safety Aspects of Selective Anti-VEGF Therapy

ROP in the developing retina of premature infants is unique because of the coexistence of physiological and pathological angiogenesis. The type of structure of the vascular nodes is the way to understand the selective treatment of ROP. Purpose. Identification of criteria for the selective ROP treatment choice using the type of pathological vasculogenesis. Material and methods. The study included 279 patients with ROP – 1 group (stage I), 152 (304 eyes); group 2 (stage II) – 45 (90 eyes); 3 group (III stage) – 8 (12 eyes); group 4 (IVA stage) –7 (8 eyes); 5 group (posterior aggressive ROP) – 7 (14 eyes); group 6 (immature retina) 60 (120 eyes) – control; 231 (188 eyes) patients with ROP referred for surgical treatment, divided into subgroups before and after lasercoagulation of the retina. Fractal dimension (Df) and complexity of vascular system (СVS) on wide-field images were assessed. Results. In the group before treatment Df 1.4374 ± 0.03, CVS 2.8 ± 0.14, in the group after treatment Df 1.3756 ± 0.03, CVS 2.3 ± 0.21. According to the morphometric data of 12 images, Df (p = 0.004) and CCC (p = 0.02) values were statistically different in subgroups before and after treatment. Low values of Df (< 1.34) may indicate a more pronounced shift of angiogenesis towards pathological, since normally Df of the formed vasculature is 1.7. In this case, it is preferable to use anti-VEGF therapy. Conclusion. The Df and CVS are indicators are relevant parameters for evaluating the effectiveness of laser treatment in patients with ROP. Vascular patterns are unique for each post-conceptual age, CVS and Df are potential markers of the balance between pathological and physiological angiogenesis for the selective choice of ROP therapy. Keywords: retinopathy of prematurity, retinal laser photocoagulation, retinal vascular system, antiVEGF