Abstract
Purpose :
With the increasing use of anti-VEGF treatments for Retinopathy of Prematurity (ROP), this study aims to compare the long-term risk of ocular diseases between patients treated with anti-VEGF injections and those receiving traditional laser photocoagulation.
Methods :
TriNetX database (Cambridge, MA, USA) was used to perform a retrospective cohort study. ICD-10 code H35.1 was used to identify patients with ROP before age 1. Two cohorts were created: those who received laser therapy and those who received anti-VEGF agents within 3 months of ROP diagnosis. Patients were excluded if they had any other form of treatment (e.g. cryotherapy, scleral buckling, and vitrectomy). Propensity score matching (PSM; 1:1) was employed to balance cohorts in terms of demographics, stages of ROP, respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, and other identified risk factors of ROP; gestational age and birth weight were also adjusted when available. Post-PSM, hazard ratios (HR) with 95% confidence intervals (CI) were assessed for the following primary outcomes at 10 years: strabismus, refractive disorders, amblyopia, glaucoma, and infantile/juvenile cataracts. If HR could not be obtained due to low case counts, absolute risk (%) was calculated. Patients with pre-existing diagnoses of these outcomes were excluded from the study.
Results :
Inclusion criteria were met by 590 patients treated with anti-VEGF, and 1,633 patients treated with laser. Post PSM, each cohort was comprised of 452 patients. There was no significant difference in risk for esotropia (HR: 0.996, 95% CI: 0.706-1.406), exotropia (HR: 1.116, 95% CI: 0.653-1.906), myopia (HR: 0.703, 95% CI: 0.529-0.935), hyperopia (HR: 0.897, 95% CI: 0.631-1.276), astigmatism (HR: 0.684, 95% CI: 0.508-0.921), amblyopia (HR: 0.759, 95% CI: 0.539-1.067), and glaucoma (HR: 7.054, 95% CI: 0.867-57.388) between the two cohorts. Notably, a significant excess absolute risk was identified for infantile/juvenile cataracts (2.217%, p=0.0015) in patients treated with anti-VEGF, compared to their counterparts; these occurred exclusively in the anti-VEGF cohort.
Conclusions :
Anti-VEGF treatment in ROP patients shows an increased risk of infantile/juvenile cataracts compared to laser photocoagulation, with other ophthalmic disease risks being similar. Future studies are necessary to further explore these associations.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.