This systematic review compared neurodevelopmental outcomes in premature infants treated with intravitreal anti-VEGF (primarily bevacizumab or ranibizumab) versus laser photocoagulation surgery (LPC) as primary treatment for retinopathy of prematurity (ROP), synthesizing 26 studies (3 RCTs + 22 cohort studies) spanning 2006–2022 across 39 countries.
77% of studies (20/26), including all RCTs, found no statistically significant difference in neurodevelopmental outcomes between anti-VEGF and LPC; 4 studies found worse outcomes with intravitreal bevacizumab and 2 found worse outcomes with LPC. None of the 5 studies that included IQ testing beyond age 4 detected a significant difference between treatment groups.
No study was powered specifically for neurodevelopmental outcomes, limiting ability to detect small but clinically meaningful differences. Most assessments (54%) were done before age 24 months, and long-term cognitive data (IQ beyond age 4) were available in only 19% of studies. No level I (RCT-powered for neurodevelopment) evidence exists.
Based on current level II–III evidence, neither anti-VEGF nor LPC appears to confer a clear neurodevelopmental advantage for primary ROP treatment. Clinicians should remain cautious about long-term outcomes given sparse data beyond early childhood, and ongoing follow-up of treated infants into school age is warranted.
Explore related topics
