Oral propranolol versus placebo for retinopathy of prematurity: a pilot, randomised, double-blind prospective study

Retinopathy of prematurity (ROP) can progress to neovascularisation (NV) and retinal detachment. Laser photocoagulation1 or intravitreal bevacizumab (Avastin)2 are the current interventions for severe ROP. Vascular endothelial growth factor (VEGF) plays a key role in ROP pathogenesis, being downregulated and upregulated in vaso-obliterative and vaso-proliferative phases of ROP, respectively. ROP and infantile haemangiomas share the same VEGF-mediated pathogenesis. Propranolol downregulates VEGF expression, and thus, mitigates progression of infantile haemangiomas3 and NV in oxygen-induced retinopathy in animals.4 We examined the safety and feasibility of propranolol for ROP. Twenty premature infants with ROP, born between 1 May 2010 and 31 July 2012 at 24–28 weeks’ gestation and birth weight <1500 g, were randomised either to oral propranolol (propranolol+sucrose 5%; n=10) or placebo (sucrose 5%; n=10) (figure 1). Inclusion criterion: evidence for ROP with any of the following: (a) stage 1 (zone I); (b) stage 2 or …