Infants Can Tolerate Anti-VEGF Treatment for Retinopathy of Prematurity

Premature Baby Retinopathy
Retinopathy In Premature Infant. Retinal Fluorescein Angiogram Showing Hypoxia Of The Retinal Periphery. Recolorized, Black And White Image. (Photo By BSIP/UIG Via Getty Images)
An international, large-scale study evaluates practice patterns, complications and outcomes of intravitreal injections for retinopathy of prematurity.

Despite differences in practice patterns, intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs can be well tolerated in infants for the treatment of retinopathy of prematurity (ROP), according to an international, large-scale study published in Ophthalmology.  

Researchers conducted a study of infants with ROP treated with intravitreal anti-VEGF injections between 2007 and 2021. A total of 23 sites (16 in the US and 7 outside the US) participated in the study. Data obtained included demographics, birth characteristics, exam findings, and injection methods. Researchers compared US sites with non-US sites. 

A total of 1677 eyes from 918 infants with ROP (57% boys, 43% girls) were included in the study. The average gestational age was 25.7 weeks (range: 21.2-41.5 weeks), and average birth weight was 787 grams (range 300-2700 grams). A 30 gauge needle was most commonly used (51%) and injections were most frequently performed in the inferior-temporal quadrant (51.3%). Bevacizumab was the most commonly employed anti-VEGF (71.4%), with a dose of 0.625 mg in 64% of cases.  

Overall, 604 eyes (36%) required retreatment with laser or further anti-VEGF injection. Of those, 482 eyes (79.8%) were retreated with laser alone, 64 eyes (10.6%) were retreated with anti-VEGF injection alone, and 58 eyes (9.6%) were retreated with combined laser and injection. 

Complications after anti-VEGF injections occurred in 15 eyes (0.9%), and included vitreous hemorrhage, cataract formation, conjunctivitis, subconjunctival hemorrhage, and corneal abrasion. No serious complications such as endophthalmitis or retina detachments were reported. 

Infants in the US had lower birth weights and gestational ages (665.6 grams and 24.5 weeks, respectively) compared with non-US infants (912.7 grams and 26.9 weeks, respectively) (P <.0001). Retreatment with reinjection and laser was significantly more frequent in the US compared with the non-US group (8.5% vs 4.7% [P =.0016] and 55% vs 7.2% [P <.001], respectively). The researchers found no difference in the incidence of complications between the 2 geographical subgroups.

“In this large-scale study on the real-world use of anti-VEGF therapy for ROP, intravitreal injections were safe and effective with no cases of endophthalmitis, despite a variance of practice patterns in and outside the US,” according to the researchers. 

Study limitations included its retrospective design, inability to accurately determine long-term outcomes such as true rate of retinal detachment, and inability to evaluate meaningful outcomes in terms of variability based on international socioeconomic status, geography, or population. 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. This research was supported by Retina Innovation Fund. Please see the original reference for a full list of disclosures.


Patel NA, Acaba-Berrocal LA, Hoyek S, et al. Practice patterns and outcomes of intravitreal anti-vegf injection for retinopathy of prematurity – an international multicenter study. Ophthalmol. Published online July 18, 2022. doi:10.1016/j.ophtha.2022.07.009