Impact of anti-VEGF therapy versus laser therapy on mortality and treatment outcomes in retinopathy of prematurity: A systematic review and meta-analysis.

Purpose: Retinopathy of prematurity (ROP) is a major cause of childhood blindness, and selecting the optimal treatment between anti-vascular endothelial growth factor (anti-VEGF) and laser therapy is crucial. Understanding their impact on key outcomes, particularly mortality, is essential for informed clinical decision-making.

Methods: A systematic literature search identified published studies comparing anti-VEGF and laser therapy for ROP up to December 31, 2024. Primary outcomes included mortality, retinal detachment, surgical interventions, myopia and neurodevelopmental outcomes. The risk of bias was assessed using the Cochrane Risk of Bias Tool and ROBINS-I. Data were synthesized using a random-effects model, with risk ratios (RR) and 95% confidence interval (CI). This review is registered in PROSPERO (CRD42024585336).

Results: A total of 12 randomized controlled trials (RCTs) and 58 observational studies, covering 10 516 infants, were included. Anti-VEGF therapy was associated with a higher mortality risk than laser therapy (RR: 1.68; 95% CI: 1.23-2.30), primarily in observational studies (1.85; 1.32-2.60), while RCTs showed no significant difference (1.02; 0.46-2.26). Anti-VEGF therapy was linked to lower risks of retinal detachment (0.36; 0.27-0.50), fewer surgical interventions (0.38; 0.22-0.65), and a lower risk of myopia (0.67; 0.54-0.82). No significant differences were found in neurodevelopmental outcomes (1.05; 0.96-1.15).

Conclusions: Anti-VEGF therapy offers benefits over laser treatment, including reduced retinal detachment, fewer surgeries and lower myopia risk, with no observed increase in mortality or neurodevelopmental impairment. Future large-scale RCTs are needed to clarify mortality risks while minimising the impact of confounding factors.