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  • Fewer retinal detachments in infants given anti-VEGF vs. laser therapy

    Pediatric Ophth/Strabismus

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    Review of: Retinal detachment after treatment of retinopathy of prematurity with laser versus intravitreal anti-vascular endothelial growth factor

    Barry G, Yu Y, Ying G-S, et al. Ophthalmology, August 2021

    A secondary analysis of data from 2 Postnatal Growth and ROP (G-ROP) studies compared anti-VEGF treatment with laser therapy for short-term prevention of retinal detachment in type 1 retinopathy of prematurity (ROP).

    Study design

    Using data from 2 nonrandomized North American comparative cohort studies, investigators compared anti-VEGF and laser therapy in preventing short-term retinal detachment in type 1 ROP. In total, results from 1167 eyes from 640 infants were analyzed.

    Outcomes

    For type 1 ROP, anti-VEGF treatment showed a significantly decreased rate of retinal detachment in the short term (8 weeks post-treatment) compared with laser therapy in those infants treated before 36 weeks’ postmenstrual age (PMA) (0% vs. 7.9%, respectively). In infants treated after 36 weeks’ PMA, the anti-VEGF and laser therapy options each had low rates of retinal detachment at 8 weeks post-treatment (1.4% vs. 3.1%, respectively).

    Limitations

    While 1003 eyes received laser treatment, only 164 eyes received anti-VEGF treatment. The fewer number of eyes with anti-VEGF treatment may have limited the power to detect differences in gestational age groups. Furthermore, this study assessed short-term outcomes (within 8 weeks of treatment) and did not analyze long-term outcomes, including the eventual need for laser therapy in eyes treated with anti-VEGF therapy.

    Clinical significance

    Treatment with anti-VEGF injection for type 1 ROP in premature infants (<36 weeks’ PMA) was associated with lower rates of retinal detachment at 8 weeks post-treatment compared with laser therapy. However, this benefit must be balanced with the risks of anti-VEGF treatment, including long-term structural and visual acuity outcomes.