Paired-eye comparison of photocoagulation versus intravitreal bevacizumab for retinopathy of prematurity: long-term visual, refractive, and ocular biometric outcomes at corrected ages 1, 5, and 9 years.

PURPOSE: To evaluate long-term outcomes of photocoagulation (PC) and intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP).

STUDY

DESIGN

Retrospective paired-eye comparison.

METHODS

Twenty-one patients (42 eyes) treated for ROP between 2009-2010 were included. In each subject, one eye received PC and the fellow IVB. Visual acuity (VA), refraction (spherical equivalent [SE], cylinder power [CP], corneal astigmatism [CA]), and ocular biometry (corneal curvature radius, anterior chamber depth [ACD], lens thickness [LT], and axial length [AL]) were assessed at corrected ages of 1, 5, and 9 years. Cross-sectional differences were analyzed using the Wilcoxon signed-rank test, with Bonferroni correction applied at 9 years. Annual rates of change were evaluated using a linear mixed-effects model (LMM). Inter-treatment differences were assessed using Spearman correlation analysis.

RESULTS

At 9 years, PC-treated eyes showed significantly worse VA, greater myopia, and shorter AL (all p < 0.05). ACD was deeper in IVB-treated eyes, while CP and CA were greater in PC-treated eyes. LMM revealed a significantly faster progression of myopia and CP in PC-treated eyes. Conversely, the annual rates of ACD deepening and LT thinning were significantly faster in IVB-treated eyes, whereas no significant differences were observed for VA or AL. Inter-treatment differences in SE were significantly correlated with AL differences, whereas VA differences were correlated with ACD.

CONCLUSION

IVB-treated eyes showed better VA, less myopia, and more favorable refractive and biometric parameters. SE differences were associated with AL, whereas VA differences were associated with ACD, indicating distinct structural mechanisms.