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Cohort studyJournal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus · 2026

Real-world outcomes of retinopathy of prematurity treated with primary laser versus primary anti-vascular endothelial growth factor and deferred laser.

Melissa Yuan, Daniel Hu, Francisco Altamirano … Ryan Gise

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OphthalmologyCohort study

Early deferred anti-VEGF laser linked to better vision than primary laser in retinopathy of prematurity

Real-world outcomes of retinopathy of prematurity treated with primary laser versus primary anti-vascular endothelial growth factor and deferred laser.

Melissa Yuan … Ryan Gise

Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus · 2026

Purpose

To compare visual and anatomic outcomes between primary laser photocoagulation and anti-vascular endothelial growth factor (VEGF) therapy with early or late deferred laser treatment (for reactivation or peripheral avascular retina [PAR]) in management of retinopathy of prematurity (retinopathy of prematurity).

Methods

In this retrospective cohort study, eyes were divided into three groups: primary laser, anti-VEGF with early (<4 months) deferred laser, and anti-VEGF with late (≥4 months) deferred laser (treated prophylactically for PAR per protocol or for reactivation if needed).

n = 260 eyes

logMAR 0.14

Results

logMAR 0.14

Sharper vision score in early-deferred group vs 0.18 in the other two groups

n = 260 eyes

More results

The primary laser group was older at first treatment (median postmenstrual age, 39.1 weeks vs 36.1 and 35.7 weeks for early- and late-deferred laser groups [P < 0.01]).

Zone 1 disease was more common in anti-VEGF groups (43%-45% vs 1.9% [P < 0.01]).

More results

Retinal detachment rates were not significantly different (3.1% primary laser vs 0.0% in anti-VEGF groups [P = 0.31] when excluding 2 eyes of 1 patient with numerous missed examinations and an atypical follow-up schedule due to medical instability in the early deferred laser group).

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Conclusion · 1 of 2

Primary laser and anti-VEGF with deferred laser showed comparable anatomic outcomes. Refractive outcomes were comparable, though myopia was common in all groups.

Conclusion · 2 of 2

Anti-VEGF was more commonly used for posterior disease, reflecting contemporary practice patterns at this quaternary referral center.

Post

Real-world outcomes of retinopathy of prematurity treated with primary laser versus primary anti-vascular endothelial growth factor and deferred laser.

Early deferred anti-VEGF laser linked to better vision than primary laser in retinopathy of prematurity

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