Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 16;24(4):676-687.
doi: 10.17305/bb.2023.9829.

Efficacy of four anti-vascular endothelial growth factor agents and laser treatment for retinopathy of prematurity: A network meta-analysis

Yufei Xu  1 , Guohua Deng  2 , Jun Zhang  2 , Jie Zhu  2 , Zhinan Liu  2 , Fan Xu  3 , Dong Zhou  2
Affiliations

Efficacy of four anti-vascular endothelial growth factor agents and laser treatment for retinopathy of prematurity: A network meta-analysis

Yufei Xu et al. Biomol Biomed. .

Abstract

This study undertakes a comprehensive comparison of five different interventions for the treatment of type-1 retinopathy of prematurity (ROP) and aggressive posterior ROP (APROP), offering insights into their relative efficacies and contributing to better clinical decision making. The aim of this study was to compare the efficacy of intravitreal aflibercept (IVA), intravitreal bevacizumab (IVB), intravitreal conbercept (IVC), intravitreal ranibizumab (IVR), and laser therapy in treating these conditions. We conducted a search for relevant randomized controlled trials (RCTs) in databases, namely, PubMed, Embase, Cochrane Library, Web of Science, and Ovid, focusing on these five treatment modalities for ROP. The quality of the included studies was evaluated using the Cochrane Risk of Bias Assessment Tool, and data analysis was performed using STATA software. The results from our network meta-analysis (NMA) indicated that IVA significantly prolonged the interval between initial treatment and relapse in patients, with a surface under the cumulative ranking curve (SUCRA) value of 99.1%. Additionally, patients in the IVB group had a significantly higher spherical equivalent refraction (SER) after surgery, with a SUCRA value of 84.4%. Furthermore, IVR was the most effective in reducing the duration of peripheral retinal vascularization, with a SUCRA value of 95.6%. However, no statistically significant differences were found in relapse rates among the five treatment options. Our analysis concludes that intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drug monotherapy generally offer better outcomes than laser treatment for ROP. Nonetheless, additional RCTs are necessary to further evaluate the safety of anti-VEGF agents.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: Authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow diagram presenting the selection strategy.
Figure 2.
Figure 2.
Graph illustrating the risk of bias within the 26 included RCTs, across the different biases. RCTs: Randomized controlled trials.
Figure 3.
Figure 3.
Network graph generated for the recurrence interval of each intervention. Each node in the network graph corresponds to a specific intervention within the NMA, with the node size representing the intervention’s relative weight. The thickness of connecting lines corresponds to the quantity of the included relevant publications. NMA: Network meta-analysis; IVC: Intravitreal conbercept; IVR: Intravitreal ranibizumab; IVA: Intravitreal aflibercept; IVB: Intravitreal bevacizumab.
Figure 4.
Figure 4.
Network graph generated for the SER of each intervention. Each node in the network graph corresponds to a specific intervention within the NMA, with the node size representing the intervention’s relative weight. The thickness of connecting lines corresponds to the quantity of the included relevant publications. SER: Spherical equivalent refraction; NMA: Network meta-analysis; IVB: Intravitreal bevacizumab; IVA: Intravitreal aflibercept; IVR: Intravitreal ranibizumab.
Figure 5.
Figure 5.
Network graph generated for the recurrence prevalence of each intervention. Each node in the network graph corresponds to a specific intervention within the NMA, with the node size representing the intervention’s relative weight. The thickness of connecting lines corresponds to the quantity of the included relevant publications. NMA: Network meta-analysis; IVA: Intravitreal aflibercept; IVB: Intravitreal bevacizumab; IVR: Intravitreal ranibizumab; IVC: Intravitreal conbercept.
Figure 6.
Figure 6.
Network graph generated for the duration of peripheral retinal vascularization of each intervention. Each node in the network graph corresponds to a specific intervention within the NMA, with the node size representing the intervention’s relative weight. The thickness of connecting lines corresponds to the quantity of the included relevant publications. NMA: Network meta-analysis; IVA: Intravitreal aflibercept; IVR: Intravitreal ranibizumab; IVB: Intravitreal bevacizumab.
Figure 7.
Figure 7.
SUCRA plots displaying the probability of each interventions’s effectiveness in extending the recurrence interval for ROP. SUCRA: Surface under the cumulative ranking curve; ROP: Retinopathy of prematurity; IVA: Intravitreal aflibercept; IVB: Intravitreal bevacizumab; IVC: Intravitreal conbercept; IVR: Intravitreal ranibizumab.
Figure 8.
Figure 8.
SUCRA plots displaying the probability of each interventions’s effectiveness in improving SER for ROP. SUCRA: Surface under the cumulative ranking curve; SER: Spherical equivalent refraction; ROP: Retinopathy of prematurity; IVA: Intravitreal aflibercept; IVB: Intravitreal bevacizumab; IVR: Intravitreal ranibizumab.
Figure 9.
Figure 9.
SUCRA plots displaying the probability of each interventions’s effectiveness in reducing recurrence prevalence. SUCRA: Surface under the cumulative ranking curve; IVA: Intravitreal aflibercept; IVB: Intravitreal bevacizumab; IVC: Intravitreal conbercept; IVR: Intravitreal ranibizumab.
Figure 10.
Figure 10.
SUCRA plots displaying the probability of each interventions’s effectiveness in reducing the duration of peripheral retinal vascularization. SUCRA: Surface under the cumulative ranking curve; IVA: Intravitreal aflibercept; IVB: Intravitreal bevacizumab; IVR: Intravitreal ranibizumab.
Figure 11.
Figure 11.
Funnel plots assessing publication bias for various outcomes. (A) Recurrence interval; (B) Spherical equivalent refraction; (C) Recurrence rate; (D) Duration of peripheral retinal vascularization. A: Intravitreal aflibercept; B: Intravitreal bevacizumab; C: Intravitreal conbercept; D: Intravitreal ranibizumab; E: Laser.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Dogra M, Katoch D, Dogra M. An update on retinopathy of prematurity (ROP) Ind J Pediatr. 2017;84(12):930–6. https://doi.org/10.1007/s12098-017-2404-3. - PubMed
    1. Morrison D, Shaffer J, Ying G-S, Binenbaum G. Ocular complications following treatment in the postnatal growth and retinopathy of prematurity (G-ROP) study. J AAPOS. 2018;22(2):128–33. https://doi.org/10.1016/j.jaapos.2017.12.005. - PMC - PubMed
    1. Quimson S. Retinopathy of prematurity: pathogenesis and current treatment options. Neonatal Netw. 2015;34(5):284–7. https://doi.org/10.1891/0730-0832.34.5.284. - PubMed
    1. Tan Q, Christiansen SP, Wang J. Development of refractive error in children treated for retinopathy of prematurity with anti-vascular endothelial growth factor (anti-VEGF) agents: a meta-analysis and systematic review. PLoS One. 2019;14(12):e0225643. https://doi.org/10.1371/journal.pone.0225643. - PMC - PubMed
    1. Chen P, Rossin E, Vavvas D. Aflibercept for retinopathy of prematurity: a systematic review and meta-analysis. Ophthalmic Surg Lasers Imaging Retina. 2021;52(12):673–81. https://doi.org/10.3928/23258160-20211124-01. - PubMed

Publication types

MeSH terms