Objective: Laser photocoagulation (LPC) has been a traditional treatment for retinopathy of prematurity (ROP). However, intravitreal anti-VEGF agents such as bevacizumab and intravitreal ranibizumab (IVR) have also been increasingly used. This meta-analysis aims to rigorously compare IVR to LPC in the treatment of ROP. Methods: Meta-analysis. Methods: One thousand nine hundred forty-seven eyes from 1007 infants were included. Methods: Medline, Embase, and Cochrane CENTRAL were used to identify studies comparing IVR monotherapy to LPC (PROSPERO ID: CRD42023390855). The primary outcome was ROP regression. Secondary outcomes included likelihood of additional treatment, time from treatment to reactivation or retreatment, refractive outcomes, and adverse events such as retinal detachment, cataract, macular dragging/ectopia, vitreous or retinal hemorrhage, glaucoma, and endophthalmitis. A random-effects meta-analysis was designed. Results: A total of 2361 articles were identified. One thousand nine hundred forty-seven eyes from 7 cohort studies, 1 case-control study, and 2 randomized controlled trials were included with a median follow-up of 21 months (range, 11-75 months). There was no significant difference in disease regression between IVR and LPC (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.83-1.10; P = 0.52); however, eyes that underwent IVR were associated with a higher likelihood of requiring additional treatment (RR, 2.70; CI, 1.55-4.68; P < 0.001). Although less frequent, retreatment occurred earlier with LPC compared with IVR (weighted mean difference [WMD], -4.29 weeks; CI, -6.48 to -2.10; P < 0.001). Furthermore, eyes that received IVR had a lower refractive error, with a WMD of -0.93 diopters (CI, -1.54 to -0.32; P = 0.003) at a median age of assessment of 5.0 years (range, 1.5-6.3 years). There was no difference in the rate of adverse events between LPC and IVR (P > 0.05 for RD, MDR, VH, and cataract). Quality of evidence was rated moderate for likelihood and time of additional treatment, as well as refractive error, but was considered low for disease regression and adverse events. Conclusions: Compared with LPC, IVR was associated with a higher likelihood of requiring additional treatment but a lower risk of myopia. More studies are needed to evaluate dose-response relationships and temporal trends in ROP regression after these treatments.

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