Long‐term observation of the treatment of laser photocoagulation versus intravitreal bevacizumab in identical twins with aggressive posterior retinopathy of prematurity

Abstract Purpose In recent years, a number of studies have been reported comparing the results of the treatment with intravitreal bevacizumab injection. We report a case of comparing effects of laser photocoagulation versus intravitreal bevacizumab injection in identical twins with AP‐ROP. Methods GA 28 + 2 weeks, identical twins were born with 0.97 and 1.02 kg. Twins were diagnosed as bilateral AP‐ROP and they were refered to different hospital due to the lack of hospital neonatal room, and they received different treatments. At the PMA 32 + 6 weeks, the older sister underwent bilateral intravitreal bevacizumab injection, younger sister underwent laser photocoagulation. Younger sister underwent bilateral laser photocoagulation at the PMA 34 + 4 weeks and received additional bilateral intravitreal bevacizumab injection after 1week. Older sister underwent second intravitreal bevacizumab injection at the PMA 42 + 2 weeks. Results After 9 years, older sister’s BCVA was checked 0.8 in the right eye, 0.25 in the left eye. Both eyes showed good angiogenesis to the periphery of the retina and fovea showed normal development on the OCT. And younger sister’s BCVA was checked 0.5 in the right eye, FC 50cm in the left eye. Laser was well applied at the periphery, but the retinal vessels didn’t grow even in the zone 1 main arcade, and the fovea on the OCT was irregular and undeveloped. Conclusions In this case, the intravitreal bevacizumab injection in the same twin with all the same conditions supports the efficacy of bevacizumab injections because of better long‐term outcome of anatomical and functional retinal vessel development. There is no reported case of different initial treatment in Identical twin, so it can be a meaningful case to compare long term results of two treatments.