Impact of different treatment approaches on long-term refractive and visual outcomes in retinopathy of prematurity

To evaluate the long-term refractive and visual outcomes in infants with retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB), laser photocoagulation (LPC), or combined IVB+LPC therapy, and to assess disease severity on refractive development over five years.

This retrospective cohort study analyzed data from infants diagnosed with ROP between 2013 and 2018. Patients were categorized into four groups: IVB (n=44), LPC (n=41), IVB+LPC (n=17), and regressed ROP (RROP, n=50). A subgroup analysis was performed for Type 1 ROP and aggressive ROP (AROP). Primary outcomes included spherical equivalent (SE), astigmatism, and visual acuity (logMAR), measured at 6-month intervals up to 60mo.

The study included 152 patients (76 females). The mean birth weight was 1256.1±555.6 g, and the mean week of birth was 29.1±2.9wk. RROP infants had the highest SE, closest to emmetropia. The IVB+LPC group showed the most significant myopic shift compared to other groups (P<0.05). In Type 1 ROP, SE was lower in the IVB+LPC group initially, but by 60mo, the difference was not significant. Astigmatism was higher in the LPC group at later time points (36–60mo). However, no differences in visual acuity were observed at the final follow-up among treatment groups.

Refractive outcomes vary more in Type 1 ROP than AROP. IVB+LPC results in greater myopia; LPC is associated with increased astigmatism. Individualized refractive follow-up is essential, particularly for Type 1 ROP.