High retreatment rate for intravitreal anti-VEGF injections for ROP

This study described treatment patterns of intravitreal anti-VEGF injections for retinopathy of prematurity (ROP) and measured retreatments and complication rates.

Study design

This multicenter, international, retrospective series evaluated treatment patterns of intravitreal anti-VEGF injections for the treatment of retinopathy of prematurity (ROP). In all, 1677 eyes of 918 patients were included in this consecutive series. The main outcome measure was the number and type of retreatments required as well as complication rates.

Outcomes

Of the eyes treated, 36% (304 eyes) required retreatment. Of eyes requiring re-treatment, the most common modality was laser alone (79.8% of retreatments). Complications occurred in 15 eyes (0.9%), and there were no cases of endophthalmitis. The most common anti-VEGF agent utilized was bevacizumab (71.4%) and the most common dose was 0.625 mg (64%). When comparing US-based centers with international centers, there was no difference in the rate of complications after anti-VEGF injection. Retreatment with re-injection (p = 0.0016) or laser (p < 0.001) was significantly more common in the US.

Limitations

Infants treated in the US had lower birth weights and gestational ages compared with international patients, possibly limiting comparison of practice patterns, re-treatment rates, and complication rates. The dose and type of anti-VEGF agent used varied from center to center. Injection procedure, including distance from the limbus, was not standardized.

Clinical significance

As the use of anti-VEGF injections for the treatment of ROP becomes more commonplace, data regarding re-treatment and complication rates are helpful in guiding expectations. Longer-term data on visual and anatomic outcomes will be of special interest.