Use of anti-vascular endothelial growth factor (antiVEGF) in the treatment of retinopathy of prematurity (ROP) – A systematic review and a metaanalysis

Introduction: Retinopathy of prematurity (ROP) is one of the leading causes of blindness in children worldwide. The management of ROP has been revolutionised with the introduction of intravitreal anti-vascular endothelial growth factor (antiVEGF) agents. This review evaluates the safety and efficacy of intravitreal antiVEGF agents when used either as monotherapy, or in combination with laser/cryo in preterm infants with type 1 ROP.
Methods: A comprehensive literature search was conducted from 2000 to April 2022 using the following databases PubMed, EMBASE and CINHAL. Total of 12 randomised controlled studies (RCTs) and 7 comparative studies were selected after critical appraisal. RCTs were included in the meta analysis.
Results: There were 4628 eyes of 2571 infants with type 1 ROP were identified from the included studies. A meta analysis showed no statistically significant difference in retinal detachment, ROP recurrence, mortality and cerebral palsy between standard treatment (laser/cryo) and antiVEGF mono therapy. AntiVEGF mono therapy may reduce the risk of refractive errors in childhood compared to standard therapy. No significant risk of acute and long-term systemic complications noted with antiVEGF therapy.
Conclusion: AntiVEGF agents, as monotherapy is non inferior to standard therapy after evaluating for risk of retinal detachment and recurrence of ROP in infants with type 1 ROP. The data is not sufficient to make strong conclusions favouring routine use anti-VEGF agents as monotherapy in all types of type 1 ROP. Hence, further large scale RCTs with longer follow up period are necessary to evaluate the safety and efficacy of antiVEGF agents for type 1 ROP.