Clinical outcomes of laser versus combined laser and ranibizumab treatment for type 1 retinopathy of prematurity in zone 1

Title : Clinical outcomes of laser versus combined laser and ranibizumab treatment for type 1 retinopathy of prematurity in zone 1

Abstract:

Aim: To evaluate the anatomical and refractive outcomes in patients with type 1 retinopathy of prematurity in zone 1.

Materials and methods: The study included 77 preterm infants (154 eyes) between 2020 and 2025 and analyzed retrospectively and prospectively. Patients were divided into three treatment groups:
Group I (25 patients, 50 eyes): conventional transpupillary laser coagulation of the retina (TPLCR).
Group II (28 patients, 56 eyes): intravitreal injection of ranibizumab (0.2 mg/0.02 ml) combined with gentle TPLCR.
Group III (24 patients, 48 eyes): intravitreal injection of ranibizumab with deferred TPLCR.
Anatomical outcomes, including disease regression, macular ectopia, and retinal detachment, as well as refractive outcomes, were compared among the three groups.

Results: The mean gestational age and birth weight of the cohort (n = 77) were 26.3 ± 1.2 weeks and 749 ± 159 g, respectively. In Group I, retinal detachment was observed in 6 patients (12 eyes, 24%), and macular ectopia was identified in 4 patients (8 eyes, 16%). In Group II, all eyes achieved a favorable anatomical outcome, with no evidence of reactivation or need for retreatment (p < 0.001). In Group III, retinal detachment developed in 3 patients (6 eyes, 12.5%). Refractive outcomes (spherical equivalent) demonstrated the highest degree of myopia in Group I (–7.44 ± 7.01 D), followed by Group III (–3.67 ± 2.13 D), while Group II showed the least myopic shift (–1.38 ± 2.19 D, p < 0.001).

Conclusion: In the management of type 1 retinopathy of prematurity in zone 1, intravitreal injection of ranibizumab combined with gentle laser photocoagulation achieved superior anatomical outcomes compared with conventional or deferred laser photocoagulation. Deferred treatment necessitates strict and closely monitored follow-up. Furthermore, this combined approach resulted in the lowest degree of myopic refractive error.

Biography:

Sabina Asylbekovna Smagulova, born on January 1, 1988, is a PhD candidate at the Higher School of Public Health. She completed her residency in Ophthalmology, including Pediatric Ophthalmology, at the Kazakh Research Institute of Eye Diseases in Almaty. From 2013 to 2025, she worked as an ophthalmologist at the same institute and currently practices at the Medical Center for Eye Care in Almaty.Her main professional areas include laser surgery for retinopathy of prematurity, anti-VEGF therapy, and the treatment of congenital posterior segment eye pathologies.She actively participates in international ophthalmology conferences and contributes significantly to the advancement of pediatric ophthalmology in Kazakhstan.