Primary and additional treatment preference in aggressive retinopathy of prematurity and type 1 retinopathy of prematurity

Abstract

ObjectiveThis study aimed to evaluate the preference for antivascular endothelial growth factor (anti-VEGF) versus laser ablation therapy as primary and additional treatment in aggressive retinopathy of prematurity (ROP) and type 1 ROP.MethodsThis multicentre retrospective study was conducted at nine medical centres across South Korea. A total of 94 preterm infants with ROP who underwent primary treatment between January 2020 and December 2021 were enrolled. All eyes were classified as having type 1 ROP or aggressive ROP. Data on the zone, primary treatment chosen, injection dose, presence of reactivation and additional treatment were collected and analysed.ResultsSeventy infants (131 eyes) with type 1 ROP and 24 infants (45 eyes) with aggressive ROP were included. Anti-VEGF injection was selected as the primary treatment in 74.05% of the infants with type 1 ROP and 88.89% with aggressive ROP. Anti-VEGF injection was selected as the ROP was located in zone I or posterior zone II, and laser ablation was selected when it was located in zone II. The anti-VEGF injection doses varied and tended to be higher in the aggressive ROP group. Infants with aggressive ROP were 2.08 times more likely to require additional treatment than those with type 1 ROP. When ROP reactivation occurred, laser therapy was preferred as an additional treatment.ConclusionIn Korea, the preference for anti-VEGF therapy or laser therapy differed according to ROP subtype, zone and primary or secondary treatment. These findings suggest that ROP treatment are considered according to ROP subtype, location and reactivation.

Characteristics of retinal vascularization in reactivated retinopathy of prematurity and clinical outcome after reinjection of ranibizumab

“…Most cases of ROP require only one or two anti-VEGF injections. 10 , laser treatment was preferred over anti-VEGF reinjection in cases requiring additional treatment. However, when anti-VEGF injections were selected, they tended to be administered at a dose equal to or higher than the rst injection.…”

“…Anti-VEGF injection offers several advantages over laser treatment such as eliminating the need for general anesthesia, providing a rapid clinical response, and permitting vascularization into the immature retina without causing permanent retinal damage 8 . Therefore, for zone I ROP or aggressive ROP, anti-VEGF treatment is more effective than laser treatment 9,10 . However, after anti-VEGF injection, the rate of retinal vascularization slows down.…”

Characteristics of retinal vascularization in reactivated retinopathy of prematurity requiring treatment and clinical outcome after reinjection of ranibizumab

“…Martínez-Castellanos et al 29 recommended that anti-VEGF injection should be repeated if ROP worsens due to inadequate technique, if elevation of ridge with new vessels is observed, and if flat new blood vessels are observed; however, vitrectomy should be performed if vitreous traction is observed above the ridge. In the Korea multicenter study 10 , laser treatment was preferred over anti-VEGF reinjection in cases requiring additional treatment. However, when anti-VEGF injections were selected, they tended to be administered at a dose equal to or higher than the first injection.…”

“…Anti-VEGF injection offers several advantages over laser treatment such as eliminating the need for general anesthesia, providing a rapid clinical response, and permitting vascularization into the immature retina without causing permanent retinal damage 8 . Therefore, for zone I ROP or aggressive ROP, anti-VEGF treatment is more effective than laser treatment 9 , 10 .…”