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Comparative Study
. 2021 Aug;128(8):1188-1196.
doi: 10.1016/j.ophtha.2020.12.028. Epub 2020 Dec 31.

Retinal Detachment after Treatment of Retinopathy of Prematurity with Laser versus Intravitreal Anti-Vascular Endothelial Growth Factor

Gerard P Barry  1 , Yinxi Yu  2 , Gui-Shuang Ying  2 , Lauren A Tomlinson  3 , Juliann Lajoie  4 , Marilyn Fisher  5 , Gil Binenbaum  3 ; G-ROP Study Group
Affiliations
Comparative Study

Retinal Detachment after Treatment of Retinopathy of Prematurity with Laser versus Intravitreal Anti-Vascular Endothelial Growth Factor

Gerard P Barry et al. Ophthalmology. 2021 Aug.

Abstract

Purpose: To compare rates of short-term retinal detachment (RD) of infants treated for type 1 retinopathy of prematurity (ROP) with intravitreal anti-vascular endothelial growth factor (VEGF) therapy with infants treated with laser therapy. The choice between these 2 treatments remains controversial. Comparative data are limited and describe re-treatment rates rather than retinal structural outcomes predictive of long-term vision. Anti-vascular endothelial growth factor acts faster than laser therapy, which may be beneficial for more aggressive ROP.

Design: Nonrandomized, comparative cohort study.

Participants: The study included 1167 eyes of 640 infants treated for type 1 ROP. Among these, 164 eyes received anti-VEGF therapy and 1003 eyes received laser therapy.

Methods: Pretreatment and posttreatment examinations and treatments were completed by ophthalmologists with expertise in ROP. The study was a secondary analysis of data from the retrospective Postnatal Growth and Retinopathy of Prematurity Study (G-ROP) 1 study (2006-2012) and the prospective G-ROP 2 study (2015-2017).

Main outcome measures: Rate of RD (ROP stages 4A, 4B, or 5) within 8 weeks of initial treatment, an end point predictive of poor long-term vision. The results were stratified by postmenstrual age (PMA) at treatment as occurring before versus at or after 36 weeks and 0 days, because earlier disease may be considered more aggressive.

Results: Among 458 eyes treated before PMA 36 weeks and 0 days, the short-term RD rate was higher after laser therapy (29/368 eyes [7.9%]) than after anti-VEGF therapy (0/90 eyes [0%]; P < 0.001). Of 709 eyes treated at or after PMA 36 weeks and 0 days, short-term RD risk did not differ between groups (laser [20/635 eyes], 3.1%; anti-VEGF [1/74 eyes], 1.4%; P = 0.27).

Conclusions: Anti-vascular endothelial growth factor therapy results in better short-term structural outcomes than laser therapy when type 1 ROP is treated before 36 weeks' PMA. After this age, both treatments have very low rates of short-term RD. The faster action of anti-VEGF agents likely is responsible for these findings.

Keywords: Anti–vascular endothelial growth factor; Laser photocoagulation; Retinal detachment; Retinopathy of prematurity.

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Conflict of interest statement

Conflict of Interest: No conflicting relationship exists for any author.

Figures

Figure 1.
Figure 1.
Flowchart of eligible eyes included and excluded in the study. AMC = Albany Medical Center, GROP 1 = Postnatal Growth and Retinopathy of Prematurity Study 1, GROP 2 = Postnatal Growth and Retinopathy of Prematurity Study 2, RD = Retinal detachment.
Figure 2.
Figure 2.
Retinal detachments within 8 weeks following treatment for type 1 retinopathy of prematurity with intravitreal anti-vascular endothelial growth factor versus laser photocoagulation, stratified by post-menstrual age before and after 36 weeks at time of treatment. Anti-VEGF = Anti-vascular endothelial growth factor, PMA = post-menstrual age, RD = Retinal detachment
See this image and copyright information in PMC

References

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