Evaluation of regression, reactivation, retreatment and retinal detachment after injections of three different anti-VEGF drugs for retinopathy of prematurity

This study aimed to compare the regression, reactivation, retreatment, and retinal detachment (RD) outcomes of eyes with type 1 retinopathy of prematurity (ROP) and aggressive ROP (A-ROP) treated with different anti-VEGF drugs: bevacizumab (IVB), ranibizumab (IVR), and aflibercept (IVA). This single-center retrospective study included infants treated with anti-VEGF therapy for type 1 ROP or A-ROP between 2014 and 2020. Ultra-widefield (UWF) retinal images were captured with Optos confocal laser ophthalmoscopy. Data on initial and retreatment injection rates, zone findings, time intervals between treatments, additional laser therapy rates and durations, and RD cases were analyzed in detail. The study included 550 eyes of 284 infants, 52.5% (149) of whom were female and 47.5% (135) of whom were male. The gestational age (GA) ranged from 22 to 33 weeks and BW ranged from 450 to 1650 g. The first injection rate across all cases was 99.8% (549) and these injections occurred at between 33 and 58 weeks. The retreatment injection rate was 9.6% (53) and these injections occurred at between 35 and 60 weeks. The time interval between injections ranged from 1 to 26 weeks. Post-injection, laser therapy was administered to 15.8% (87) of eyes. RD was observed in 1.8% (10) of eyes between 38 and 120 weeks. Initial injections for RD cases occurred significantly earlier. Anti-VEGF therapy has recently been used as an effective treatment for retinopathy of prematurity. The retreatment rate (9.6%) and RD rate (1.8%) are quite low. Long-term follow-up remains crucial for managing late reactivation and complications.