Refractive Outcomes of 4-Year-old Children after Intravitreal Anti-vascular Endothelial Growth Factor versus Laser Photocoagulation for Retinopathy of Prematurity

Abstract

Purpose: To compare long-term refractive outcomes associated with intravitreal anti-vascular endothelial growth factor (VEGF) versus laser photocoagulation treatment for retinopathy of prematurity (ROP).

Methods: A total of 52 eyes from 27 ROP patients treated at two tertiary referral-based hospitals from August 2006 to December 2013 were reviewed. The primary outcome was refractive error measured at the age of 4 years, accounting for within-patient inter-eye correlation. Secondary outcomes included the recurrence rate and treatment complications.

Results: The mean age at refraction was 4.7 ± 0.3 years in the laser group (n = 30) and 4.4 ± 0.3 years in the anti-VEGF group (n = 22). No significant differences were noted in gestational age, birthweight, post-menstrual age at treatment, or ROP stage/zone distribution between groups. Mean spherical equivalent was also not significantly different (-1.0 diopters in the laser group and -0.3 diopters in the injection group, p = 0.603). Clustered regression analysis revealed that only gestational age was significantly correlated with mean spherical equivalent (p < 0.001; 95% confidence interval, -0.007 to -0.002). Recurrence was noted in four eyes (13.3%) in the laser group, but this difference was not significant (p = 0.128). There were no major systemic complications reported in either group.

Conclusions: Treatment type, whether laser or anti-VEGF injection, does not appear to influence long-term refractive outcomes in ROP. Concern regarding refractive outcomes should not be the most important factor when selecting ROP treatment modality.

Keywords: Intravitreal injections; Laser therapy; Refractive errors; Retinopathy of prematurity; Vascular endothelial growth factor A.

Fig. 1. Distribution of the refractive outcome in spherical equivalences after treatment for retinopathy of prematurity. Refractive error was divided into six categories: very high myopia (≥−8 diopters [D]), high myopia (<−8 to −5 D), low myopia (<−5 to −1 D), emmetropia (<−1 to +1 D), low hyperopia (>+1 to +4 D), and high hyperopia (>+4 D). No significant difference was noted between treatment groups in children at the age of 4 years. VEGF = vascular endothelial growth factor.