Structural and refractive outcomes of intravitreal ranibizumab followed by laser photocoagulation for type 1 retinopathy of prematurity

PURPOSE: To evaluate refractive and structural outcomes for patients treated for retinopathy of prematurity (ROP) with the anti–vascular endothelial growth factor (anti-VEGF) agent ranibizumab and “delayed laser,” defined as any laser photocoagulation treatment administered at least 2 weeks and < 1 year after the initial anti-VEGF injection. METHODS: The medical records of infants with type 1 ROP treated between 2015 and 2020 with intravitreal 0.25 mg ranibizumab followed by delayed laser photocoagulation, with a minimum of 6 months’ follow-up, were reviewed retrospectively. Refractive and structural outcomes were extracted from the record. RESULTS: A total of 68 eyes of 34 neonates were included, with median gestational age of 24 weeks and birthweight of 657 g. Patients were aged 0.9 to 4.4 years at last follow-up; mean follow-up interval was 2.7 ± 1.02 years. There was no progression to stage 4 or 5 following treatment during the study period. At 2 years’ follow-up (mean age, 2.41 ± 0.23 years), median spherical equivalent (SE) was −0.13 D (IQR, 4.20 D). At most recent examination (mean age, 2.70 ± 1.02 years), the most common ocular findings included strabismus (32%), optic atrophy (24%), amblyopia (21%), high myopia (7%), and nystagmus (4%). CONCLUSIONS: In our small cohort, neonates with type 1 ROP treated with intravitreal ranibizumab and delayed laser demonstrated good structural outcomes, with no progression to retinal detachment. We found lower rates of high myopia compared with previous reports of laser photocoagulation monotherapy.