A Comprehensive Review: Recent Advances in the Management of Retinopathy of Prematurity (ROP)

Retinopathy of prematurity (ROP) is a unique, proliferative vasculopathy in the retina of premature infants has set off the major cause of blindness in preterm infants throughout the world. In 1940s and 1950s it is also known as Retrolental Fibrioplasia.  Propranolol, a non selective beta adrenergic receptor inhibitor is used for ROP in various studies. Propranolol is used in infantile hemangioma due to blocking of VEGF (Vascular Endothelial Growth Factor) i.e it is tested for the RNV (Retinal Neo-Vascularization).  Caffeine plays key role in the prevention of ROP progression. It is a frequently used drug in prematurity for the reduction of retinopathy in preterm infants. Adding supplementation of poly unsaturated fatty acids to the mother may mitigate the risk of ROP in premature infants. Vitamin A shows action by acting blocking of VEGF production. By providing vitamin A as a supplement during pregnancy it shows the reduction in ROP in premature infants. Exposure to the light may influence the ROP. Some studies had proven that light exposure may affect the progression of ROP. A red light exposure shows reduction in progression of ROP at 670 nm shows good results of development in ROP infants. NSAIDS such as ibuprofen and indomethacin are the widely used drugs in the treatment of ROP. Some studies have showed the effect of Insulin like growth factor - I (IGF-I) supplementation will give the potent outcomes in the management of ROP. A potential therapeutics strategy to treat ROP is with gene therapy using viral vectors. The most commonly used vector for humans can be adeno-associated virus because of its low immunogenicity. The first FDA approved adeno-associated virus gene therapy is the Voretigene neparvovec to treat inherited retinal dystrophy caused by mutation of the RPE65 gene. It is very much essential to identify the novel therapeutics for ROP as the available therapies are causing unfavourable ocular outcome and also showing long term systemic effects on other organs. Gene therapy, cell therapy and non-coding RNAs have been shown a great impact in the management of ROP and further investigations are required to investigate the emerging treatment strategies.