Related Experiment Video
Updated: Sep 4, 2025
Intravitreal Injections in the Ovine Eye
Published on: July 5, 2022
Practice Patterns and Outcomes of Intravitreal Anti-VEGF Injection for Retinopathy of Prematurity: An International
Nimesh A Patel1, Luis A Acaba-Berrocal2, Sandra Hoyek3
1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
Intravitreal anti-VEGF injections for retinopathy of prematurity (ROP) are safe, though practice patterns vary globally. US infants with ROP were younger, smaller, and received more retreatments compared to non-US infants.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Anti-vascular endothelial growth factor (anti-VEGF) agents are increasingly used to treat ROP.
- Understanding global practice patterns and outcomes of anti-VEGF therapy is crucial for optimizing treatment.
Purpose of the Study:
- To analyze practice patterns of intravitreal anti-VEGF injections for ROP.
- To evaluate outcomes, focusing on retreatment rates and complications.
- To compare treatment approaches and outcomes between the United States (US) and international sites.
Main Methods:
- Retrospective, international, multicenter study.
- Inclusion of 1677 eyes from 918 patients treated with anti-VEGF from 2007-2021.
- Data collection on demographics, birth characteristics, injection methods, retreatments, and complications.
Main Results:
- Bevacizumab was the most common anti-VEGF agent used.
- 36% of eyes required retreatment, primarily with laser therapy.
- Complications occurred in 0.9% of eyes, with no cases of endophthalmitis.
- US infants were younger and smaller, receiving more frequent retreatments than non-US infants.
Conclusions:
- Intravitreal anti-VEGF injections for ROP are safe and well-tolerated.
- Significant variations exist in treatment protocols and patient demographics globally.
- US neonates with ROP exhibited distinct characteristics and treatment trajectories compared to their international counterparts.
Purpose:
To report practice patterns of intravitreal injections of anti-VEGF for retinopathy of prematurity (ROP) and outcomes data with a focus on retreatments and complications.
Design:
Multicenter, international, retrospective, consecutive series.
Subjects:
Patients with ROP treated with anti-VEGF injections from 2007 to 2021.
Methods:
Twenfty-three sites (16 United States [US] and 7 non-US) participated. Data collected included demographics, birth characteristics, examination findings, and methods of injections. Comparisons between US and non-US sites were made.
Main Outcome Measures:
Primary outcomes included number and types of retreatments as well as complications. Secondary outcomes included specifics of the injection protocols, including types of medication, doses, distance from limbus, use of antibiotics, and quadrants where injections were delivered.
Results:
A total of 1677 eyes of 918 patients (43% female, 57% male) were included. Mean gestational age was 25.7 weeks (range, 21.2-41.5 weeks), and mean birth weight was 787 g (range, 300-2700 g). Overall, a 30-gauge needle was most commonly used (51%), and the quadrant injected was most frequently the inferior-temporal (51.3%). The distance from the limbus ranged from 0.75 to 2 mm, with 1 mm being the most common (65%). Bevacizumab was the most common anti-VEGF (71.4%), with a dose of 0.625 mg in 64% of cases. Overall, 604 (36%) eyes required retreatment. Of those, 79.8% were retreated with laser alone, 10.6% with anti-VEGF injection alone, and 9.6% with combined laser and injection. Complications after anti-VEGF injections occurred in 15 (0.9%) eyes, and no cases of endophthalmitis were reported. Patients in the United States had lower birth weights and gestational ages (665.6 g and 24.5 weeks, respectively) compared with non-US patients (912.7 g and 26.9 weeks, respectively) (P < 0.0001). Retreatment with reinjection and laser was significantly more common in the US compared with the non-US group (8.5% vs. 4.7% [P = 0.0016] and 55% vs. 7.2% [P < 0.001], respectively). There was no difference in the incidence of complications between the 2 geographic subgroups.
Conclusions:
Anti-VEGF injections for ROP were safe and well tolerated despite a variance in practice patterns. Infants with ROP receiving injections in the US tended to be younger and smaller, and they were treated earlier with more retreatments than non-US neonates with ROP.
