|Treating ROP patients with anti-VEGF was shown to have positive outcomes in this study. Click image to enlarge.|
Studies show there are benefits to treating retinopathy of prematurity (ROP) with both laser and anti-VEGF treatments, but real-world visual outcome data in ROP is limited. Because of this, researchers recently decided to evaluate ex-premature infants screened for this disorder.
A total of 175 infants were included over a nine-year period, with 15 eyes receiving anti-VEGF therapy and 59 eyes undergoing primary laser therapy.
There was an increased incidence of adverse outcomes following ROP laser, including severe myopia, amblyopia and optic atrophy. “Our group previously used anterior segment OCT to demonstrate that myopia after laser treatment is due to arrested anterior segment as opposed to axial myopia seen in non-preterm, school-aged children,” the study authors noted.
They hypothesize that there was an association between laser therapy and optic atrophy due to retrograde optic atrophy such as with heavy panretinal photocoagulation.
Less amblyopia and optic atrophy were found when comparing anti-VEGF with laser after controlling for gestational age and birth weight. The researchers noted this may be due to improved foveal development. “We believe this adds to the growing body of evidence in favor of the use of anti-VEGF agents in ROP,” they said.
“Another group has shown improved foveal development in school-aged children after anti-VEGF treatment. Therefore, the reduced incidence of amblyopia seen with anti-VEGF therapy may be due to improved foveal development compared with laser therapy, which may arrest eye development,” the investigators continued. “Taken together, in our practice we recommend that preterm children with abnormal best-corrected visual acuity without an underlying cause receive an OCT when old enough to evaluate for preterm foveal development as a cause of mild visual impairment.”
Gundlach BS, Kokhanov A, Altedahl M, et al. Real-world visual outcomes of laser and anti-VEGF treatments for retinopathy of prematurity. Am J Ophthalmol. November 8, 2021. [Epub ahead of print].