Popovic MM, Nichani P, Muni RH, Mireskandari K, Tehrani NN, Kertes PJ
Surv Ophthalmol
Publication year: 2020

Abstract

We investigate the efficacy and safety of intravitreal injection (IVI) of antivascular endothelial growth factor agents and laser photocoagulation (LPC) for retinopathy of prematurity. We performed a systematic search of Ovid MEDLINE, EMBASE, and Cochrane CENTRAL (2005–2019). Comparative studies reporting on ocular efficacy and/or safety outcomes after IVIs and LPC for retinopathy of prematurity were included. The primary outcome was the regression rate, whereas secondary endpoints included the likelihood of requiring additional treatment, visual and refractive outcomes, and complications. Overall, 777 publications were identified. Twenty-four articles were included, with 1,289 eyes receiving IVI and 2,412 eyes undergoing LPC. There was no significant difference in the regression rate between IVI and LPC (P = 0.68); however, eyes that underwent IVI were associated with a significantly higher likelihood of requiring additional treatment (risk ratio = 2.16, 95% confidence interval (CI) = [1.26, 3.73], P = 0.005) and longer time from treatment to retreatment or recurrence (weighted mean difference = 6.43 weeks, 95% CI = [2.36, 10.51], P = 0.002). Eyes receiving IVI required surgical intervention significantly less often (risk ratio = 0.45, 95% CI = [0.23, 0.89], P = 0.02). Astigmatism was significantly lower after IVI relative to LPC (weighted mean difference = −0.25 D, 95% CI = [−0.45, −0.06], P = 0.01), and there was a lower proportion of emmetropic eyes at last follow-up after LPC (risk ratio = 0.51, 95% CI = [0.27, 0.99], P = 0.05). There were no differences in visual and safety outcomes between IVI and LPC. LPC had a lower likelihood of requiring additional treatment, whereas IVIs were associated with a longer interval from treatment to retreatment or recurrence, reduced risk of surgical intervention and superior refractive outcomes. All other outcomes were comparable between IVIs and LPC.

Keywords: retinopathy of prematurity; bevacizumab; ranibizumab; lasers; laser therapy

Presentations

  1. Nichani P, Popovic MM, Muni RH, Mireskandari K, Tehrani NN, Kertes PJ. (2020). Intravitreal injections versus laser photocoagulation for retinopathy of prematurity: A meta-analysis of 3701 eyes. American Academy of Ophthalmology, Las Vegas, NV, United States (ePoster). Spotlighted by OphthalmologyAdvisor.com and PracticeUpdate.com. View ePoster with narration here.
  2. Popovic MM, Nichani P, Muni RH, Mireskandari K, Tehrani NN, Kertes PJ. (2020). Intravitreal injections versus laser photocoagulation for retinopathy of prematurity: A meta-analysis of 3701 eyes. European Society of Retina Specialists EURetina, Virtual Meeting (oral). View presentation here.
  3. Popovic MM, Nichani P, Muni RH, Mireskandari K, Tehrani NN, Kertes PJ. (2020). Intravitreal injections versus laser photocoagulation for retinopathy of prematurity: A meta-analysis of 3701 eyes. UofT Department of Ophthalmology & Vision Sciences 62nd Research Day, Toronto, ON (oral). Alumni Award for Best Resident Research Presentation. View presentation here.