Baiad Abed A, Sun Catherine, Yin Grace S, Popovic Marko M, Muni Rajeev H, Mireskandari Kamiar, Kertes Peter J
Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada.
Faculty of Medicine, McMaster University, Hamilton, Canada.
Ophthalmol Retina. 2025 Jul;9(7):677-689. doi: 10.1016/j.oret.2025.01.012. Epub 2025 Jan 20.
Laser photocoagulation (LPC) has been a traditional treatment for retinopathy of prematurity (ROP). However, intravitreal anti-VEGF agents such as bevacizumab and intravitreal ranibizumab (IVR) have also been increasingly used. This meta-analysis aims to rigorously compare IVR to LPC in the treatment of ROP.
Meta-analysis.
One thousand nine hundred forty-seven eyes from 1007 infants were included.
Medline, Embase, and Cochrane CENTRAL were used to identify studies comparing IVR monotherapy to LPC (PROSPERO ID: CRD42023390855). The primary outcome was ROP regression. Secondary outcomes included likelihood of additional treatment, time from treatment to reactivation or retreatment, refractive outcomes, and adverse events such as retinal detachment, cataract, macular dragging/ectopia, vitreous or retinal hemorrhage, glaucoma, and endophthalmitis. A random-effects meta-analysis was designed.
A total of 2361 articles were identified. One thousand nine hundred forty-seven eyes from 7 cohort studies, 1 case-control study, and 2 randomized controlled trials were included with a median follow-up of 21 months (range, 11-75 months). There was no significant difference in disease regression between IVR and LPC (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.83-1.10; P = 0.52); however, eyes that underwent IVR were associated with a higher likelihood of requiring additional treatment (RR, 2.70; CI, 1.55-4.68; P < 0.001). Although less frequent, retreatment occurred earlier with LPC compared with IVR (weighted mean difference [WMD], -4.29 weeks; CI, -6.48 to -2.10; P < 0.001). Furthermore, eyes that received IVR had a lower refractive error, with a WMD of -0.93 diopters (CI, -1.54 to -0.32; P = 0.003) at a median age of assessment of 5.0 years (range, 1.5-6.3 years). There was no difference in the rate of adverse events between LPC and IVR (P > 0.05 for RD, MDR, VH, and cataract). Quality of evidence was rated moderate for likelihood and time of additional treatment, as well as refractive error, but was considered low for disease regression and adverse events.
Compared with LPC, IVR was associated with a higher likelihood of requiring additional treatment but a lower risk of myopia. More studies are needed to evaluate dose-response relationships and temporal trends in ROP regression after these treatments.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
激光光凝术（LPC）一直是治疗早产儿视网膜病变（ROP）的传统方法。然而，玻璃体内抗血管内皮生长因子（VEGF）药物，如贝伐单抗和玻璃体内注射雷珠单抗（IVR）也越来越多地被使用。本荟萃分析旨在严格比较IVR与LPC治疗ROP的效果。
荟萃分析。
纳入了1007例婴儿的1947只眼。
使用Medline、Embase和Cochrane CENTRAL数据库来识别比较IVR单药治疗与LPC的研究（国际前瞻性系统评价注册库标识符：CRD42023390855）。主要结局是ROP消退。次要结局包括额外治疗的可能性、从治疗到复发或再次治疗的时间、屈光结局以及不良事件，如视网膜脱离、白内障、黄斑牵拉/异位、玻璃体或视网膜出血、青光眼和眼内炎。设计了一项随机效应荟萃分析。
共识别出2361篇文章。纳入了来自7项队列研究、1项病例对照研究和2项随机对照试验的1947只眼，中位随访时间为21个月（范围11 - 75个月）。IVR与LPC在疾病消退方面无显著差异（风险比[RR]，0.96；95%置信区间[CI]，0.83 - 1.10；P = 0.52）；然而，接受IVR治疗的眼睛需要额外治疗的可能性更高（RR，2.70；CI，1.55 - 4.68；P < 0.001）。与IVR相比，LPC的再次治疗虽不常见但发生时间更早（加权平均差[WMD]，-4.29周；CI，-6.48至-2.10；P < 0.001）。此外，接受IVR治疗的眼睛屈光不正较低，在中位评估年龄5.0岁（范围1.5 - 6.3岁）时，WMD为-0.93屈光度（CI，-1.54至-0.32；P = 0.003）。LPC和IVR在不良事件发生率方面无差异（视网膜脱离、黄斑牵拉、玻璃体出血和白内障的P > 0.05）。关于额外治疗的可能性和时间以及屈光不正，证据质量被评为中等，但疾病消退和不良事件的证据质量被认为较低。
与LPC相比，IVR需要额外治疗的可能性更高，但近视风险更低。需要更多研究来评估这些治疗后ROP消退的剂量 - 反应关系和时间趋势。
在本文末尾的脚注和披露中可能会发现专有或商业披露信息。
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