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Retinal Detachment after Treatment of Retinopathy of Prematurity with Laser versus Intravitreal Anti-Vascular
Gerard P Barry1, Yinxi Yu2, Gui-Shuang Ying2
1Albany Medical College, Department of Ophthalmology, Albany, New York.
Insights
Intravitreal anti-vascular endothelial growth factor (VEGF) therapy shows superior short-term structural outcomes for retinopathy of prematurity (ROP) before 36 weeks postmenstrual age compared to laser therapy. Both treatments are effective after 36 weeks.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Retinal Diseases
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Treatment choices for type 1 ROP, including anti-vascular endothelial growth factor (VEGF) therapy and laser photocoagulation, remain debated.
- Limited comparative data exist on structural outcomes predictive of long-term vision.
Purpose of the Study:
- To compare short-term retinal detachment (RD) rates in infants with type 1 ROP treated with intravitreal anti-VEGF versus laser therapy.
- To evaluate treatment efficacy based on postmenstrual age (PMA) at the time of intervention.
Main Methods:
- A nonrandomized, comparative cohort study analyzing data from the G-ROP 1 and G-ROP 2 studies.
- Included 1167 eyes of 640 infants with type 1 ROP: 164 eyes received anti-VEGF and 1003 received laser therapy.
- Short-term RD (stages 4A, 4B, or 5) within 8 weeks of treatment was the primary outcome, stratified by PMA before or at/after 36 weeks.
Main Results:
- Among 458 eyes treated before 36 weeks PMA, the RD rate was significantly higher with laser therapy (7.9%) than with anti-VEGF therapy (0%; P < 0.001).
- In 709 eyes treated at or after 36 weeks PMA, short-term RD rates did not differ significantly between laser (3.1%) and anti-VEGF (1.4%; P = 0.27) treatments.
- Anti-VEGF therapy demonstrated better short-term structural outcomes when initiated before 36 weeks PMA.
Conclusions:
- Intravitreal anti-VEGF therapy is associated with better short-term structural outcomes than laser therapy for type 1 ROP treated before 36 weeks PMA.
- Both anti-VEGF and laser therapies exhibit very low short-term RD rates when administered at or after 36 weeks PMA.
- The faster onset of action of anti-VEGF agents likely contributes to the observed superior outcomes in earlier treated ROP.
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.
