Retreatment and Reactivation Rates Following Bevacizumab, Ranibizumab, Aflibercept, and Laser for Retinopathy of Prematurity: A Systematic Review and Meta-Analysis.

Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that affects preterm newborns. Although laser therapy has been the standard of care for ROP for decades, the use of anti-VEGF agents for ROP has recently become widespread. This systematic review and meta-analysis measures and compares the retreatment and reactivation rates following laser therapy versus anti-vascular endothelial growth factor (VEGF) agents and laser for ROP. We searched Medline, Scopus, Clinical Trial, and Cochrane Library databases for all randomized controlled trials (RCTs) that have used bevacizumab, ranibizumab, aflibercept, or laser therapy for ROP. We assessed studies for risk of bias by the Critical Appraisal Skills Programme (CASP) criteria. Review Manager (RevMan) (2014) Version 5.3 was utilized to carry out the meta-analysis for our study. Five studies were included in this review. The meta-analysis has revealed that laser treatment is associated with a significantly lower risk of retreatment than anti-VEGF medications (RR = 2.11, 95% CI 1.46-3.05, p < 0.0001, I² = 92%). In the subgroup analysis conducted based on the type of anti-VEGF medication used, studies using Aflibercept and Ranibizumab reported higher retreatment rates than studies with Bevacizumab. Similarly, there was a significant difference in terms of the reactivation rates, with patients who underwent laser therapy exhibiting lower reactivation rates than the anti-VEGF groups (RR = 2.00, 95% CI: 1.47 to 2.72, p < 0.0001, I² = 93%). The subgroup analysis comparing types of anti-VEGF agents has also displayed both ranibizumab and aflibercept to have higher reactivation rates than bevacizumab. This meta-analysis demonstrates that laser therapy generally presents a notably reduced risk of retreatment and reactivation compared to ranibizumab and aflibercept, in line with prior research. Conversely, the study reveals that bevacizumab outperforms laser therapy, exhibiting lower rates of retreatment and reactivation.