Real-World Visual and Anatomical Outcomes of Laser Therapy versus Intravitreal Anti-Vascular Endothelial Growth Factor Injection for Retinopathy of Prematurity: A 10-Year Retrospective Cohort Study at a Tertiary Center in Thailand

Abstract

Purpose: To assess the visual and anatomical outcomes of retinopathy of prematurity (ROP) after treatment with laser therapy versus intravitreal anti-vascular endothelial growth factor (anti-VEGF) in real-world practice. Methods: This retrospective cohort study included preterm infants with treatment-requiring ROP that underwent either laser indirect ophthalmoscopy (LIO) or intravitreal anti-VEGF therapy at Ramathibodi Hospital from January 2012 to October 2023. Results: This study included 52 patients (104 eyes). The anti-VEGF (18 patients: 36 eyes) and LIO (34 patients: 68 eyes) groups had comparable baseline characteristics, including mean gestational age (25.80±2.81 vs 25.89±3.84 weeks; p=0.906), birth weight (693.0±34.30 vs 784.5±45.57 g; p=0.170), and mean follow-up duration (4.12±0.59 vs 4.91±0.57 years; p=0.361). Treatment occurred significantly earlier in the anti-VEGF group (postmenstrual age 33.94±0.53 vs 36.30±0.55 weeks; p=0.006). The anti-VEGF group required more follow-up visits from the initial exam until the complete regression of ROP (20.03±10.00 vs 11.80±6.03; p<0.001). The mean final visual acuity (VA) was similar between the anti-VEGF and LIO groups (logMAR 0.490 vs 0.480; p=0.852), although Zone I eyes treated with anti-VEGF tended to have better VA. Among Zone I eyes, those treated with anti-VEGF had significantly less myopia (mean spherical equivalent: −0.60 vs −12.30 D; p=0.007). Only the anti-VEGF group underwent secondary treatment, mainly for persistent avascular retina (44.4% vs 0%; p<0.001), and had treatment failure (16.7% vs 0%; p=0.002). Conclusion: Both anti-VEGF and laser therapy demonstrated nonsignificant difference in functional and anatomical outcomes in treatment-requiring ROP. Notably, Zone I eyes treated with anti-VEGF exhibited significantly less myopia versus those treated with LIO. However, the anti-VEGF group required significantly more hospital visits and secondary treatments.