Anti-VEGF versus Laser Photocoagulation Surgery for Primary Treatment of Retinopathy of Prematurity: Neurodevelopmental Outcomes: A Report by the American Academy of Ophthalmology

Why clinicians should know about it

• Picked for Neonatology (top studies of the week, 26 July 2026).
• Picked for Pediatrics and Child Health (top studies of the week, 26 July 2026): Anti‑VEGF vs laser ROP neurodevelopmental outcomes
• Picked for Ophthalmology (top studies of the week, 26 July 2026): Recent Ophthalmology research from a high-quartile journal

Abstract

PURPOSE: To review the evidence on neurodevelopmental outcomes after intravitreal anti-vascular endothelial growth factor (VEGF) compared with laser photocoagulation surgery (LPC) for primary treatment of retinopathy of prematurity (ROP). METHODS: A literature search was last conducted in the PubMed database in December 2025 without date restrictions and limited to articles published in English. The search yielded 52 articles, 26 of which met criteria for inclusion. The panel methodologist assigned ratings to the articles according to the level of evidence. RESULTS: Of the 26 articles included, 4 articles on 3 randomized controlled trials (RCTs) were rated level II evidence and 22 comparative cohort studies were rated level III evidence. The studies included infants who were treated and followed over a 17-year period from 2006 through 2022 in 39 countries. The most common neurodevelopmental test used was the Bayley Scales of Infant and Toddler Development, used in 13 studies (50%). The age at assessment ranged from 0 months corrected age to 12 years, where most studies (n = 14 [54%]) included testing of infants younger than 24 months of age. Most studies (n = 20 [77%]), including all RCTs, did not detect a statistically significant difference in neurodevelopmental outcomes after anti-VEGF compared with LPC for primary treatment of ROP. Neurodevelopmental outcomes were found to be worse among those infants treated with intravitreal bevacizumab (IVB) for primary treatment in 4 studies and among those treated with LPC for primary treatment in 2 studies. Only 5 studies (19%) included intelligence quotient (IQ) testing beyond 4 years of age, and none detected a statistically significant difference in IQ between those who received anti-VEGF (IVB in 4 studies and intravitreal ranibizumab in 1 study) compared with those who received LPC for primary treatment of ROP. CONCLUSIONS: Although no level I evidence was available, systematically reviewed studies with level II and III evidence showed no evidence that neurodevelopmental outcomes differed among infants who received anti-VEGF compared with LPC for primary treatment of ROP. A limitation to this assessment was that no study was powered for neurodevelopmental outcomes or to detect small differences in neurodevelopmental outcomes. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Abstract as published, via PubMed.