What factors guide the decision to treat with ROP laser treatment versus a repeat anti-VEGF injection in a child who has previously received anti-VEGF therapy for retinopathy of prematurity (ROP)?

In patients who have a recurrence of stage 3 neovascular ROP following anti-VEGF injection, I will typically perform laser unless the patient is systemically unstable and cannot tolerate sedation or anesthesia, or unless the patient still has very posterior disease (zone 1 or posterior zone 2). In patients with persistent avascular retina after an anti-VEGF injection, I typically observe until at least PMA 60 weeks and perform laser if they continue to have PAR.

Usually, if there is active disease with NV, I will do a repeat injection. If there is only a vascular retina, we go for laser.