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Recurrence of Retinopathy of Prematurity Following Anti-vascular Endothelial Growth Factor (Anti-VEGF) Therapy: A
Mohammed Dablouk1, Amit Chhabra2, Ahmed T Masoud3
1Internal Medicine, Mersey and West Lancashire Teaching Hospitals NHS Trust, Merseyside, GBR.
Insights
Anti-vascular endothelial growth factor (anti-VEGF) therapy for retinopathy of prematurity (ROP) has a higher recurrence risk than laser photocoagulation. Conbercept shows lower recurrence, while aflibercept outcomes are inconsistent.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness in premature infants.
- Current treatments, laser photocoagulation and anti-VEGF injections, have limitations including refractive errors and disease recurrence.
- Identifying optimal treatment strategies for ROP is crucial to prevent vision loss.
Purpose of the Study:
- To systematically review and compare recurrence rates of ROP after anti-VEGF treatment versus other anti-VEGF agents and laser photocoagulation.
- To evaluate retreatment intervals and success rates to determine the most effective ROP treatment modality.
- To provide evidence-based insights for managing ROP and minimizing long-term visual impairment.
Main Methods:
- A systematic review adhering to PRISMA guidelines, including RCTs and NCS.
- Comprehensive database searches of MEDLINE, EMBASE, Web of Science, and CENTRAL.
- Risk of Bias (Cochrane RoB2) and Newcastle-Ottawa Scale (NOS) assessments, with random-effects and fixed-effects meta-analyses.
Main Results:
- Anti-VEGF agents showed a higher ROP recurrence risk (RR=2.14) than laser photocoagulation.
- Conbercept demonstrated significantly lower recurrence than laser and ranibizumab (RR=0.47).
- Aflibercept had higher recurrence than bevacizumab (RR=12.61), while bevacizumab had longer retreatment intervals (SMD=0.89).
Conclusions:
- Anti-VEGF therapy is effective for ROP but carries a higher recurrence risk than laser photocoagulation.
- Conbercept offers superior efficacy in reducing ROP recurrence and extending retreatment intervals.
- While anti-VEGF therapy is effective, careful consideration of agent-specific recurrence risks and retreatment intervals is necessary for optimal ROP management.
Abstract:
Retinopathy of prematurity (ROP) is a neovascular disorder which affects premature infants and can lead to childhood blindness. Treatment includes laser photocoagulation and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, both effective options. However, laser photocoagulation can lead to refractive errors, while anti-VEGF therapy can result in disease recurrence. Our systematic review aimed to evaluate the recurrence rates of ROP following treatment with anti-VEGF agents compared to other anti-VEGF agents and laser photocoagulation. We also aimed to measure the retreatment intervals and assess successful retreatment rates to identify the most effective treatment modality. Our review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included both randomized controlled trials (RCTs) and non-randomized comparative studies (NCS). A thorough search of MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases was performed. Studies were assessed using the Cochrane Risk of Bias (RoB2) tool and the Newcastle-Ottawa Scale (NOS). Random-effects and fixed-effects models were used to measure pooled estimates. The outcomes were reported as risk ratios (RR) and standardized mean differences (SMD). A total of 21 studies (six RCTs and 15 NCS) with 6,152 eyes were included. Overall, anti-VEGF agents showed a higher risk of recurrence compared to laser photocoagulation (RR=2.14, 95% CI: 1.06-4.33, p=0.03). Conbercept demonstrated a significantly lower risk of recurrence than laser photocoagulation and ranibizumab (RR=0.47, 95% CI: 0.39-0.58, p<0.00001), while aflibercept showed a higher recurrence risk compared to bevacizumab (RR=12.61, 95% CI: 6.43-24.73, p<0.00001). Bevacizumab was associated with a longer retreatment interval than laser photocoagulation (SMD=0.89, 95% CI: 0.61-1.17, p<0.00001). No significant differences in retreatment success rates between bevacizumab and laser photocoagulation were observed. Anti-VEGF therapy is effective in the treatment of ROP; however, it is associated with a higher risk of recurrence compared to laser photocoagulation. Conbercept shows greater efficacy in reducing recurrence risk and prolonging the retreatment interval compared to ranibizumab. Aflibercept demonstrated inconsistent outcomes. No significant difference in recurrence rates was observed between bevacizumab and ranibizumab. Recurrences occurred significantly later when anti-VEGF therapy was used compared to laser photocoagulation. Successful retreatment rates between bevacizumab and laser photocoagulation were similar.
