Bevacizumab intravítreo no tratamento da retinopatia da prematuridade: uma revisão da literatura
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Introdução: A retinopatia da prematuridade é uma vasculopatia típica da retina imatura de crianças prematuras, sendo uma das principais causas de cegueira infantil. Nos últimos anos, vêm ganhando popularidade novas abordagens terapêuticas para a doença, com destaque para a terapia antiangiogênica com bevacizumab. Objetivo: Revisar a literatura sobre o uso do bevacizumab no tratamento da retinopatia da prematuridade, destacando sua eficácia, efeitos adversos e dosagem. Fonte de dados: Bases de dados PubMed, Medline, Lilacs e SciElo nos últimos 15 anos, utilizando-se os descritores “bevacizumab”, “retinopatia da prematuridade” e “inibidores da angiogênese” nas línguas portuguesa, inglesa e espanhola, bem como textos de diretrizes. Síntese dos dados: Diversos estudos demonstram a eficácia desse medicamento no tratamento da retinopatia do prematuro, com desfechos similares ou até melhores que a abordagem padrão (laser). Contudo, o rigor metodológico é quase sempre baixo, e outros inúmeros trabalhos apontam vários efeitos adversos oculares e sistêmicos, com base no mecanismo inibidor de angiogênese dessa droga, os quais ainda não foram adequadamente estudados. Resultados positivos com dosagens cada vez menores
trazem esperança de um tratamento efetivo e seguro. Conclusões: O uso do bevacizumab não deve ser feito como primeira escolha no manejo da retinopatia da prematuridade, até que sejam realizados ensaios clínicos randomizados rigorosos atestando definitivamente sua segurança, eficiência e esquema terapêutico adequado. Seu uso deve ser considerado em casos selecionados, como variantes mais agressivas da doença, refratárias à fotocoagulação com laser.
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