Ranibizumab and laser for ROP gave similar vision at nine years

Design

Long-term follow-up of a single-centre randomised trial

Population

29 of 50 children randomised in 2014 for zone II ROP (19 ranibizumab, 10 laser)

Primary outcome

Refraction, visual acuity, biometry, OCT and electroretinography at 9 years

Effect

Spherical equivalent −1.90 vs −1.22 D, difference 0.68 D (−2.26 to 3.62); acuity 0.21 vs 0.15 logMAR

This follow-up, published in the European Journal of Pediatrics on 28 September, revisited a single-centre trial that in 2014 randomised 50 infants with stage 2 or 3 zone II retinopathy of prematurity with plus disease to ranibizumab or laser. At about nine years, 29 children were examined: 19 from the ranibizumab arm and 10 from the laser arm.

Mean spherical equivalent (−1.90 vs −1.22 D) and best-corrected acuity (0.21 vs 0.15 logMAR) did not differ significantly. Ranibizumab-treated eyes had thinner lenses, slightly steeper corneas and thinner central retinas, and some electroretinogram measures differed. The authors call these differences exploratory.

The common concern is that anti-VEGF may have hidden long-term costs, while laser is known to cause more myopia. In this small cohort, school-age vision and refraction were similar, so the choice can rest on disease zone, access, follow-up reliability and reactivation risk. Both groups need long-term follow-up.

• Base the choice between anti-VEGF and laser on zone, access and follow-up reliability, not on school-age vision alone.
• After anti-VEGF, keep screening until vascularisation is complete; reactivation can be late.
• Arrange refraction and eye checks through childhood for all treated infants.
• Tell families that long-term vision was similar in this small study.
• Record which treatment was given, so later findings can be interpreted.

Why it matters

Fear of hidden long-term harm from anti-VEGF found little support in school-age vision here.

Don't overread it

Only 29 of 50 children were seen, unevenly by arm; it cannot exclude real differences.

The statistics, in plain English

A mean difference in spherical equivalent of 0.68 D with an interval from −2.26 to 3.62 is compatible with a large difference either way; the study was too small to rule one out. Uneven loss to follow-up (19 vs 10 children) can also bias the comparison.

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