Refractive, Visual and Retinal Outcomes after Intravitreal Ranibizumab Monotherapy for Retinopathy of Prematurity

Nora Hassan Alhassan1, *, Foziyah Abohaimed2, Maram Albalawi3, Amal Aldarwesh1, Omar Aldibasi3, 4, Mohammed Hazzazi2, 4, Rania Medhat Fahmy1, 5
1 Department of Optometry, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
2 Department of Ophthalmology, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
3 Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.
4 King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
5 Department of Ophthalmology, Faculty of Medicine, Cairo University, Giza, Egypt

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© 2023 Alhassan et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Optometry, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia; E-mail:



Intravitreal ranibizumab (IVR) is increasingly used as an off-label treatment for retinopathy of prematurity (ROP). The most clinically used dose is 0.25 mg; however, its late outcomes are rarely reported. This study compares the late refractive, visual, and retinal outcomes in children with type 1 ROP treated with 0.25 mg IVR to those with type 2 ROP that regressed spontaneously.


This retrospective study included 48 children (96 eyes) with ROP history. Birth history data, spherical equivalent (SE) of cycloplegic refraction, and the prevalence of visual and retinal anomalies were compared between type 1 (68 eyes) and type 2 ROP (28 eyes).


At a mean age of 3.47 years, children with type 1 ROP had significantly lower mean SE (+0.17D ± 3.60) than children with type 2 ROP (+1.99D ± 2.80) (P = 0.02). SE was significantly affected by repeated injections of IVR, leading to a reduction of SE and myopic shift. Risk factors of high myopia (SE ≤ -5 diopters) include the presence of respiratory distress syndrome (RDS) (P = 0.01), advanced maternal age (P=0.02), in vitro fertilization (IVF) (P = 0.02), ROP type 1 (P = 0.01) ROP in zone 1 (P = 0.01) and repeated IVR treatment (P= 0.01). No significant difference was found between ROP types in the prevalence of hyperopia, myopia or emmetropia. The prevalence of visual anomalies (strabismus, fixation anomalies, nystagmus, amblyopia, and extraocular imbalances) and retinal anomalies (anomalies of the retinal surface, vasculature, and optic disc) were not significantly different between the groups.


IVR monotherapy with 0.25 mg for ROP resulted in the myopic shift. Repeated IVR treatment increases the risk of high myopia. High myopia is also significantly associated with RDS, IVF, advanced maternal age, type 1 ROP, and ROP in zone 1. No association was found between IVR and visual or retinal anomalies.

Keywords : IVR , Intravitreal ranibizumab , Refractive outcomes , ROP , Visual outcomes , Retinopathy of Prematurity, Anti-VEGF.