Practice Patterns and Outcomes of Intravitreal Anti-VEGF Injection for Retinopathy of Prematurity - An International Multicenter Study


Patel NA, Acaba-Berrocal LA, Hoyek S, Fan KC, Martinez-Castellanos MA, Baumal CR, Harper AC, Berrocal AM, of (ROPIC) RPIC. Practice Patterns and Outcomes of Intravitreal Anti-VEGF Injection for Retinopathy of Prematurity - An International Multicenter Study. Ophthalmology 2022;

Date Published:

2022 Jul 18


PURPOSE: To report practice patterns of intravitreal injections of anti-Vascular Endothelial Growth Factor (VEGF) for Retinopathy of Prematurity (ROP) and outcomes data with a focus on retreatments and complications. DESIGN: Multicenter, international, retrospective, consecutive series. SUBJECTS: Patients with ROP treated with anti-VEGF injections from 2007 to 2021. METHODS: Twenty-three sites (16 Unites States [US] and 7 non-US sites) participated. Data collected included demographics, birth characteristics, exam findings, and methods of injections. Comparisons between US and non-US sites were made. MAIN OUTCOME MEASURES: Primary outcomes included number and types of retreatments as well as complications. Secondary outcomes included specifics of the injection protocols including types of medication, doses, distance from limbus, use of antibiotics, and quadrants where injections were delivered. RESULTS: A total of 1677 eyes of 918 patients (43% females, 57% males) were included. Mean gestational age was 25.7 weeks (range 21.2-41.5), and mean birth weight was 787 g (range 300-2,700). Overall, a 30 G needle was most commonly utilized (51%) and the quadrant injected was most frequently the inferior-temporal (51.3%). The distance from the limbus ranged from 0.75 to 2 mm, 1 mm being the most common (65%). Bevacizumab was the most common anti-VEGF (71.4%), with a dose of 0.625 mg in 64% of cases. Overall, 604 (36%) of eyes required retreatment. Of those, 79.8% were retreated with laser alone, 10.6% with anti-VEGF injection alone, and 9.6% with combined laser and injection. Complications following anti-VEGF injections occurred in 15 (0.9%) eyes and no cases of endophthalmitis were reported. Patients in the US had lower birth weights and gestational ages (665.6 g and 24.5 weeks, respectively) compared to non-US patients (912.7 g and 26.9 weeks, respectively) (p<0.0001). Retreatment with reinjection and laser was significantly more common in the US compared to the non-US group (8.5% vs 4.7% [p=0.0016] and 55% vs 7.2% [p<0.001], respectively). There was no difference in the incidence of complications between the two geographical subgroups. CONCLUSION: Anti-VEGF injections for ROP were safe and well tolerated despite a variance in practice patterns. Infants with ROP receiving injections in the United States tended to be younger, smaller, and were treated earlier with more re-treatments than non-United States neonates with ROP.

Last updated on 07/31/2022