Background: Early birth and various oxygen techniques can cause retinopathy of prematurity
(ROP), a widespread childhood visual problem. An aggressive ROP (A-ROP) differs from normal
progression. Diode laser replaced cryotherapy. Laser treatment is customary but limited, prompting
anti-VEGF research. BEAT-ROP aids anti-VEGF. Aim: Compare efficacy and safety of laser
photocoagulation with intravitreal anti-VEGF agents for ROP. Methods: Retrospective study at
Qena university hospital, adhering to Helsinki Declaration. Participants had ROP type 1 or AROP, treated with anti-VEGF or laser within 72 hours (or 24 hours for A-ROP) between 2021
and 2024 at Qena University, followed for ≥6 months. ICROP criteria guided diagnosis and
classification. Treatment decision involved parental consultation; unfit patients for general anesthesia
received anti-VEGF. Patients anticipated to have poor adherence to follow up received antiVEGF. Post-treatment follow-ups evaluated efficacy, with cycloplegic refraction at 6 months.
Outcome measures included regression, reactivation, and retinal detachment. Results: Significant
differences observed between Anti-VEGF and Laser groups in Zone-I ROP and APROP
parameters. No significant variation in sex distribution, gestational age (GA), birth weight, or followup duration in Zone-I. In Zone-II, significant differences in GA, birth weight, and follow-up duration.
Anti-VEGF demonstrated superior outcomes in initial regression, reactivation, and retinal detachment. Conclusion: Anti-VEGF therapy, notably Ranibizumab, outperforms laser photocoagulation
for ROP treatment in aggressive forms in Zone I. This appears to show better initial regression,
lesser reactivation, and lower retinal detachment. Anti-VEGF therapy, and laser photocoagulation
for ROP treatment in Zone II appears to show comparable initial regression and retinal detachment but laser show lesser reactivation than Anti-VEGF therapy. Research in clinical practice
is needed.