We investigate the efficacy and safety of intravitreal injection (IVI) of anti-vascular endothelial growth factor agents and laser photocoagulation (LPC) for retinopathy of prematurity (ROP). We performed a systematic search of Ovid MEDLINE, EMBASE and Cochrane CENTRAL (2005-2019). Comparative studies reporting on ocular efficacy and/or safety outcomes following IVIs and LPC for ROP were included. The primary outcome was the regression rate, while secondary endpoints included the likelihood of requiring additional treatment, visual and refractive outcomes, and complications. Overall, 777 publications were identified. Twenty-four articles were included, with 1289 eyes receiving IVI and 2412 eyes undergoing LPC. There was no significant difference in the regression rate between IVI and LPC (p=0.68); however eyes that underwent IVI were associated with a significantly higher likelihood of requiring additional treatment (RR=2.16, 95%CI=[1.26,3.73], p=0.005) and longer time from treatment to retreatment or recurrence (WMD=6.43 weeks, 95%CI=[2.36,10.51], p=0.002). Eyes receiving IVI required surgical intervention significantly less often (RR=0.45, 95%CI=[0.23,0.89], p=0.02). Astigmatism was significantly lower following IVI relative to LPC (WMD=-0.25D, 95%CI=[-0.45,-0.06], p=0.01), and there was a lower proportion of emmetropic eyes at last follow-up after LPC (RR=0.51, 95%CI=[0.27,0.99], p=0.05). There were no differences in visual and safety outcomes between IVI and LPC. LPC had a lower likelihood of requiring additional treatment, while IVIs were associated with a longer interval from treatment to retreatment or recurrence, reduced risk of surgical intervention and superior refractive outcomes. All other outcomes were comparable between IVIs and LPC.
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