# Anti-VEGF versus laser therapy for retinopathy of prematurity: a systematic review and meta-analysis focusing on recurrence patterns and retreatment needs

## TL;DR

This study compares anti-VEGF therapy and laser treatment for retinopathy of prematurity, finding similar recurrence rates but higher risks in Zone II disease.

## Contribution

The study provides a systematic review and meta-analysis comparing anti-VEGF and laser therapy for ROP recurrence and retreatment.

## Key findings

- Anti-VEGF therapy showed lower recurrence in Zone I but higher in Zone II ROP.
- Ranibizumab was associated with higher recurrence compared to other anti-VEGF agents.
- Recurrence occurred between 7 and 50+ weeks post-treatment with anti-VEGF therapy.

## Abstract

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. Anti-vascular endothelial growth factor (anti-VEGF) therapy offers an alternative to laser photocoagulation, recurrence, and retreatment, particularly in Zone II disease.

We conducted a systematic review and meta-analysis of studies published from 2010 to 2025 comparing anti-VEGF agents (bevacizumab, ranibizumab, aflibercept) with laser therapy in preterm infants with treatment-requiring ROP. Primary outcomes were recurrence and retreatment; secondary outcomes included time to recurrence, structural, and refractive outcomes. The risk of bias was assessed using RoB 2 and ROBINS-I tools, and the certainty of evidence was evaluated using GRADE.

Fifteen studies with 1,784 eyes were included. Pooled recurrence (RR 1.78, 95% CI: 0.56–5.65) and retreatment rates (RR 1.80, 95% CI: 0.54–5.94) showed no statistically significant differences, with substantial heterogeneity (I²>80%). Subgroup analysis showed lower recurrence in Zone I (RR 0.52) but higher recurrence in Zone II (RR 3.42) following anti-VEGF therapy. Ranibizumab was associated with higher recurrence compared to other agents. After anti-VEGF therapy, recurrence occurred variably between 7 and 50 + weeks of post-treatment. GRADE assessment indicated low certainty for recurrence and retreatment, moderate for structural and refractive outcomes, and very low for neurodevelopmental safety.

Anti-VEGF therapy is effective for Zone I ROP, but Zone II treatment requires careful monitoring due to higher recurrence and retreatment risk. Standardized protocols and extended follow-up are essential, and further high-quality studies are needed to optimize ROP management.

The online version contains supplementary material available at 10.1186/s40942-026-00810-9.