Real-world outcomes of retinopathy of prematurity treated with primary laser versus primary anti-vascular endothelial growth factor and deferred laser.

PURPOSE: To compare visual and anatomic outcomes between primary laser photocoagulation and anti-vascular endothelial growth factor (VEGF) therapy with early or late deferred laser treatment (for reactivation or peripheral avascular retina [PAR]) in management of retinopathy of prematurity (ROP).

METHODS

In this retrospective cohort study, eyes were divided into three groups: primary laser, anti-VEGF with early (<4 months) deferred laser, and anti-VEGF with late (≥4 months) deferred laser (treated prophylactically for PAR per protocol or for reactivation if needed).

RESULTS

A total of 260 eyes of 139 patients treated for ROP between 2013 and 2023 were included: 159 eyes in the primary group, 20 in the early-deferred group, and 81 in the late-deferred group. The primary laser group was older at first treatment (median postmenstrual age, 39.1 weeks vs 36.1 and 35.7 weeks for early- and late-deferred laser groups [P < 0.01]). Zone 1 disease was more common in anti-VEGF groups (43%-45% vs 1.9% [P < 0.01]). At median follow-up of 35 months, visual acuity was better in the early-deferred laser group (logMAR 0.14) than in the primary laser (0.18) and late-deferred laser (0.18) groups (P < 0.001; 162 eyes of 91 patients). Retinal detachment rates were not significantly different (3.1% primary laser vs 0.0% in anti-VEGF groups [P = 0.31] when excluding 2 eyes of 1 patient with numerous missed examinations and an atypical follow-up schedule due to medical instability in the early deferred laser group). At 2 years, the early-deferred laser group was more myopic (median, -1.50 D vs 0.0 D and 0.50 D [P = 0.031]). There were no differences in adverse events, strabismus, or amblyopia (P > 0.05 for all).

CONCLUSIONS

Primary laser and anti-VEGF with deferred laser showed comparable anatomic outcomes. Refractive outcomes were comparable, though myopia was common in all groups. Anti-VEGF was more commonly used for posterior disease, reflecting contemporary practice patterns at this quaternary referral center.