Anti-vascular endothelial growth factor (anti-VEGF) compared with laser photocoagulation for the treatment of retinopathy of prematurity type 1

Introduction Retinopathy of prematurity (ROP) is a condition that affects preterm infants, being the second leading cause of childhood blindness worldwide. The most commonly used treatments are cryotherapy or laser photocoagulation, but over the last few years, anti-vascular endothelial growth factor (anti-VEGF) drugs have gradually gained more adherents, mainly in the treatment of patients with type 1 retinopathy of prematurity (ET- ROP) Therefore, it is important to summarize the existing evidence to evaluate the efficacy and safety of anti-VEGF drugs in type 1 retinopathy of prematurity. Methods We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions We identified six systematic reviews including 15 studies overall, of which five were randomized trials. We conclude that the use of anti-VEGF compared to laser photocoagulation, probably reduces the risk of refractive errors. On the other hand, the use of anti-VEGF may result in little or no difference in the mortality at hospital discharge, lens or corneal opacity requiring surgery, and complete or partial retinal detachment, but the certainty of the evidence is low. Finally, it is not possible to clearly establish whether anti-VEGF compared with laser photocoagulation, increases the recurrence of retinopathy of prematurity, because the certainty of the existing evidence has been assessed as very low.