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The aim of the study is to compare the efficacy of intravitreal ranibizumab injection, intravitreal ranibizumab injection combined with retinal laser ablation, and intravitreal bevacizumab injection in treatment of zone and posterior zone 2 severe threshold retinopathy of prematurity (ROP).

Patients and methods:

A retrospective review was conducted on 21 patients with zone 1 and posterior zone 2 vascularly active ROP. The cohort was divided into 3 matched groups. Sixteen cases (Group A) received an intravitreal injection of ranibizumab (0.25mg/0.025 ml) as a sole therapeutic technique. Fourteen case (Group B) received intravitreal injection of ranibizumab (0.625 mg/0.05 ml) 3-5 days prior to laser treatment. Twelve cases (Group C) received intravitreal bevacizumab (0.625 mg/0.25 ml) as the only treatment. Postoperative follow-up was done at 1st day, 1st week, and then every 2 weeks till 4th month. RetCam (Clarity Medical Systems, Inc., Pleasanton, CA) photography was performed to document the response. Primary outcome was regression of neovessels and achievement of normal maturity. Secondary outcomes included any ocular or systemic adverse effects and requirement of additional treatments.


In group A, all eyes had regression and normal maturity was achieved in all eyes between 2 weeks and 3 months post-injection, no other treatments were required and no complications developed. In group B, 13 cases had regression of their ROP, 40% of eyes achieved maturity between 1.5 months and 3.5 months. One eye only developed premacular hemorrhage requiring pars plana vitrectomy and two eyes had tractional fold requiring vitrectomy in a single case. In group C, regression occurred in 10 of the twelve cases, maturity occurred in 40% of cases between 1 month and 3 months. One eye developed tractional retinal detachment requiring lens-sparing vitrectomy and one eye developed mild dragging of the fovea.


The best outcome was in group A (ranibuzimab) in which all cases achieved maturity with no complications and without addition of other treatments. Group C (bevacizumab) showed progression to retinal detachment in a single case and group B (Bevacizumab and laser) showed progressionin 3 cases. Laser therapy in addition to anti-VEGF may not be indicated in threshold ROP.