Laser Photocoagulation Subsequent to Intravitreal Ranibizumab for Retinopathy of Prematurity Long-Term Efficacy in Extremely Low Birth Weight Twins.

Abstract

Purpose: To evaluate the long-term efficacy of laser photocoagulation (LP) subsequent to intravitreal ranibizumab (IVR) for retinopathy of prematurity (ROP) in extremely low birth weight (ELBW) twins. Methods: In this matched case-control retrospective study, ELBW (birth weight < 1000 g) twins developed Type I ROP or AROP who received IVR and LP consecutively (IVR + LP) grouped between July 2019 and May 2022 were reviewed. Primary structural outcome was assessed at 12 months postoperatively. Physical assessments, comprising ophthalmic, systemic, and neurodevelopmental evaluations were performed at a chronological age of 24-36 months. Children with spontaneous regression of ROP, matched by sex and age (±3 months) to the IVR + LP group in a 1:1 ratio, were defined as the control group. The independent t-test and Wilcoxon rank-sum test were used to analyze and describe the demography, morphology, and treatment outcomes. Results: Twenty-four twins (48 eyes) with the mean gestational age (GA) and body weight (BW) at birth of 27.5 ± 1.7 weeks and 831.4 ± 140.9 g, respectively, were analyzed. Aggressive ROP in Zone I was observed in 8 eyes (16.7%). Stage 3+ disease was observed in 2 eyes (4.1%) in Zone I and 17 eyes (35.4%) in Zone II posterior. The median duration between IVR and LP was 197.5 days (range: 28-237 days). The reduction of cumulative clock hours (CCH) of ROP lesion showed a statistically significant difference after IVR (p < 0.05). The median laser spots count was 204 (range: 139-503), and the laser power ranged from 100 to 130 mW. Long-term follow-up physical examinations, including ophthalmic, systemic, and neurodevelopmental assessments, revealed no statistically significant differences between the IVR + LP and control groups. Notably, there were no differences in axial length (AL) and spherical equivalent (SE) (p < 0.05). Conclusion: LP following IVR treatment provides long-term effective outcomes for ROP in ELBW twins, without affecting ophthalmic, systemic, or neurological development, and reduces the risk of myopia compared to LP monotherapy.