Topical Dexamethasone for ROP Can Forestall Invasive Treatments in Some Infants

Preterm infants can be at risk for various health complications. Ocularly, infants may develop retinopathy of prematurity (ROP), which can result in devastating visual outcomes. A newly published study in Ophthalmology outlines how one more recent option—topical dexamethasone—could substantially improve treatment for those affected. These images from the study show dexamethasone treatment effects in a boy born at gestational age 25 weeks and one day. Right eye, temporal (A) and nasal (B) view. White arrows mark the border between vascular and avascular retina. He was treated with one drop daily in both eyes for four weeks and one drop every other day for another two weeks OD, and for another three weeks OS. Results are shown at postmenstrual age 35 weeks (C), 38 weeks (D) and 47 weeks (E). Photo: Gränse LAKC, et al. Ophthalmology. September 29, 2025. Click image to enlarge. The eye drop was used specifically to estimate the risk of progression from type 2 ROP to a level of severity requiring traditional treatments. Four Swedish sites were included in the data, with preterm infants born before 30 weeks’ gestation from 2015 to 2018 serving as the control years and from 2020 to 2021 as the intervention years. One of the four sites served as the intervention site, where topical dexamethasone was introduced when type 2 ROP was diagnosed.It was found that traditional ROP treatment at the intervention site fell from 72% to 13% in those with severe ROP, with a drop from 5.6% to 1.8% in all screened infants. In control sites, traditional ROP treatment increased from 47% to 56%, while in all screened infants, the rate dropped slightly from 8.6% to 7.3%. An adjusted interaction odds ratio was determined to be 0.05% for infants with the severe disease form—suggesting markedly larger decline in occurrence of traditional ROP treatments at the intervention location.In the discussion section of their paper, the researchers elaborate that most cases receiving the dexamethasone drops had regression of severe ROP occurring within four weeks. In the most advanced cases, though, the drops were continued after postmenstrual week 40. Encouragingly, none of the infants included in this study who received the eye drops had any reactivation of ROP three years following their final screening visit.The drug also has a mild anti-VEGF effect, but a much shorter half-life of about seven hours, when compared with traditional anti-VEGF agents used for intravitreal injections with type 1 ROP. Despite this, reactivation with anti-VEGF is common, typically occurring between 37 to 60 weeks postmenstrual age, but instances have been reported up to two or three years after injection—resulting in frequent, stressful exams over an extended period for affected infants.However, the investigators do note that dexamethasone can cause systemic effects. Dexamethasone is a potent steroid, so even small volumes “necessitate careful consideration of potential local and systemic side effects such as glaucoma, cataract formation, adrenocortical insufficiency, growth restriction and neurological effects,” the researchers warn.The authors comment that “a timely administration of low-dose dexamethasone eye drops may serve as a simple, cost-effective and noninvasive intervention to reduce one of the leading causes of severe visual impairment worldwide.”Click here for the journal source. Gränse LAKC, Öhnell HMV, Holmström G, et al. Treating retinopathy of prematurity with dexamethasone eye drops: a difference-in-differences study in Sweden using register data. Ophthalmology. September 29, 2025. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.