Long term visual and neurodevelopmental outcomes in ROP patients treated with laser photocoagulation versus intravitreal anti-VEGF therapy

Abstract

Purpose : Over the past 20 years, the mainstay of treatment for retinopathy of prematurity (ROP) has changed from laser photocoagulation therapy to intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF). Despite the change in therapy, little is known about the long term outcomes associated with anti-VEGF agents. We performed a retrospective, observational study to determine if there is a difference in the long-term visual and neurodevelopmental outcomes of patients who were treated with laser photocoagulation versus patients treated with an anti-VEGF injection.

Methods : Out of 105 patients who were treated for ROP at Rush University, 24 patients met the inclusion criteria of having at least 1 follow up appointment. 14 were treated using laser photocoagulation, and 10 were treated with an anti-VEGF agent (bevacizumab or ranibizumab). We analyzed visual acuity, ocular alignment, refractive errors, presence of amblyopia, presence of a diagnosed neurodevelopmental disorder, and other notable ocular abnormalities. A student’s t-test and a Chi square test were used for statistical analysis.

Results : Analysis of our results showed that patients treated with laser therapy were more likely to be amblyopic than those treated with an anti-VEGF agent (50% versus 10%, p=0.04). Additionally, there was a statistically significant difference in the sphere of patients, with laser treatment patients being more myopic (-8 D versus -2.06 D, p=0.01). However, the average age at last eye visit has been identified as a possible confounding variable, with the average age being 12 years for patients treated with laser therapy (SD = 2.59) and 2 years for those treated with anti-VEGF (SD = 1.20). Visual acuity could not be analyzed since only one patient in the anti-VEGF group was able to read the eye chart. Analysis of all other categories analyzed revealed no statistically significant differences.

Conclusions : Our results showed a statistically significant difference for two of the outcomes analyzed. Patients treated with laser therapy were more likely to be amblyopic and were more myopic than those treated with an anti-VEGF agent. Further research would include an age-matched, larger sample size. If our results are confirmed, this would suggest a benefit of administering anti-VEGF injections over laser photocoagulation.

This is a 2020 ARVO Annual Meeting abstract.