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The authors evaluated the risk factors and treatment outcomes of various treatment options for APROP including intra-vitreal anti-VEGF injections, laser treatment and a combination of both. This was an observational study of all consecutive cases of untreated APROP from 2018-19 (18-month period) including 31 infants (60 eyes) with APROP after two weeks of initial treatment. Treatment with anti-VEGF only included 26 eyes, with laser only in 19 eyes and combined treatment in 15 eyes. There were 22 males and nine females. Mean gestational age was 30.1 ±2.65 weeks. Laser treatment-only eyes had significantly higher gestational age to other treatment groups. There was a mean birth weight of 1327 ±344.83g. The combined treated group had lower gestational age and low birth weight and had late presentation, likely related to longer hospital stay. They also had maximum number and duration of ventilation support with longer neonatal intensive care unit (NICU) stay. Fifty-five percent of infants had poor pupillary dilation and significant improvement in dilation was seen mainly in the anti-VEGF group. There were 36 eyes with zone I and 24 with zone II APROP. Forty-nine eyes showed disease regression at the end of a three-month period. Regression at one week after treatment was lowest for the laser treatment group but not significantly different in regression to other groups at three months. There was no significant difference in recurrence or progression in any treatment group. Overall, regression was noted in 81.6% of infants with any treatment. The authors prefer combined treatment for infants with lower birth weight, longer NICU stay and vascularisation in zone I ROP. They recommend anti-VEGF treatment for infants with poor pupillary dilation which subsequently allowed better retinal visualisation and complete laser treatment. They recommend laser treatment for older and larger infants with vascularisation in zone II.

An observational study of different treatment practices for aggressive posterior ROP.
Kumari A, Surve A, Azad SV, et al.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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