National versus international practice patterns and outcomes of intravitreal anti-VEGF injection for retinopathy of prematurity

Abstract

Purpose : There is a lack of consensus guidelines regarding intravitreal anti-vascular endothelial growth factor (VEGF) therapy for retinopathy of prematurity (ROP). This multicenter, retrospective, consecutive series compares national and international practice patterns and outcomes data of intravitreal injections for ROP.

Methods : Subgroup analysis from the ROP Injection Consortium (ROPIC) data from 23 sites (16 national from the USA and 7 international from Canada, Chile, Dominican Republic, Japan, Mexico, Taiwan and Turkey) from 2007 to 2021. Primary outcomes included rates and types of retreatment as well as complications. Secondary outcomes included specifics of the injection protocol.

Results : 1677 eyes (873 national and 804 international) of 918 patients were included. Mean birth weight and gestational age were lower in the national (665.6 g and 24.5 weeks respectively) compared with the international group (912.7 g and 26.9 weeks respectively) (p<0.0001). The percentage of APROP and plus disease were higher in the national (26.2% and 88.7%, respectively) compared with the international group (8.7% and 81.9% respectively) (p=0.0001). Ranibizumab was used more frequently in the national group (30.9% versus 17.4%; p<0.0001) versus Aflibercept in the international group (5.3% versus 0.8%; p<0.0001). Ranibizumab dosage was lower in the national (0.15 mg in 75.2%) compared to the international group (0.25 mg in 65.7%). Intravitreal injection was administered with a 32-gauge short needle in 48.2% of national cases versus 5.5% of international cases (p<0.0001) where a 30-gauge needle was primarily used (68.2%). Rates of retreatment with anti-VEGF reinjection or laser post-injection were higher in the national compared to the international group (8.5% vs 4.7% [p=0.0016] and 55% vs 7.2% [p<0.001] respectively). Average time to retreatment with laser was longer nationally (134.2 days vs. 36.4 days, p<0.0001). However, retreatment time with injection was similar between both groups (62.2 vs. 48.7; p=0.082). There was no difference in the incidence of complications including endophthalmitis between the two geographical subgroups.

Conclusions : ROP treatment paradigms vary depending on geography. Infants with ROP receiving anti-VEGF injection nationally tended to be younger, smaller, treated earlier, and have more anti-VEGF retreatments compared to international neonates with ROP.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.