Comparison of Clinical and Angiographic Outcomes of Ranibizumab and Aflibercept in Type 1 and Aggressive Retinopathy of Prematurity.

Abstract

Background: To compare the clinical and angiographic outcomes of aggressive retinopathy of prematurity (A-ROP) and type 1 retinopathy of prematurity (ROP) treated with intravitreal injection of ranibizumab (IVR) or aflibercept (IVA).

Methods: This retrospective, non-randomised study included a consecutive series of patients with type 1 ROP or A-ROP who initially treated with ranibizumab (0.25 mg/0.025 mL) or aflibercept (1.0 mg/0.025 mL) between October 2017 and November 2020. Clinical data and long-term vascular characteristics were analysed.

Results: A total of 297 eyes of 151 infants were included. Compared to IVA, IVR was a significant risk factor for reactivation in multivariate regression analysis. The risk time of reactivation in A-ROP and Type 1 Zone I ROP was shorter in the IVR group (p < 0.001). Fewer injections were required in the IVA group for patients with A-ROP and Type 1 Zone I ROP (p = 0.012). More vascular abnormalities were observed in the IVA group during reactivation, with increased arteriovenous shunting (p = 0.028) in Type 1 Zone II ROP and more tortuosity (p = 0.047), dilation (p = 0.047) and plus disease (p = 0.020) in Type 1 Zone I ROP and A-ROP. In fundus fluorescein angiography, staining of the vessel wall and telangiectasia were more frequent in the IVA group.

Conclusions: Ranibizumab treatment was associated with a higher rate of reactivation and a shorter risk period for reactivation compared to aflibercept, potentially requiring more frequent injections, though some differences did not reach statistical significance. However, there were more signs of vascular abnormalities after receiving aflibercept treatment.