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Treating Retinopathy of Prematurity with Dexamethasone Eye Drops : A Difference-in-Differences Study in Sweden Using Register Data

Gränse, Lotta A K C LU orcid ; Öhnell, Hanna Maria V LU orcid ; Holmström, Gerd ; Sundgren, Johanna C LU ; Fahnehjelm, Kristina Teär ; Wallin, Agneta ; Larsson, Eva ; Tsamadou, Despoina ; Björklund, Lars J LU and Hellström, Ann , et al. (2026) In Ophthalmology 133(2). p.248-256
Abstract

PURPOSE: To estimate the effect of dexamethasone eye drops on the risk of progression from type 2 retinopathy of prematurity (ROP) to ROP requiring traditional treatments.

DESIGN: Register-based cohort study.

PARTICIPANTS: Preterm infants born before 30 weeks' gestation from 2015-2018 (control years) and from 2020-2021 (intervention years) registered in the Swedish Quality Register for ROP at 4 Swedish sites were included. In 1 of these sites, the intervention site, topical dexamethasone was introduced during the later period when type 2 ROP was diagnosed.

METHODS: The frequency of traditional ROP treatments (laser ablation or intravitreal injection of anti-VEGF) was compared between the 2 periods at sites that had and... (More)

PURPOSE: To estimate the effect of dexamethasone eye drops on the risk of progression from type 2 retinopathy of prematurity (ROP) to ROP requiring traditional treatments.

DESIGN: Register-based cohort study.

PARTICIPANTS: Preterm infants born before 30 weeks' gestation from 2015-2018 (control years) and from 2020-2021 (intervention years) registered in the Swedish Quality Register for ROP at 4 Swedish sites were included. In 1 of these sites, the intervention site, topical dexamethasone was introduced during the later period when type 2 ROP was diagnosed.

METHODS: The frequency of traditional ROP treatments (laser ablation or intravitreal injection of anti-VEGF) was compared between the 2 periods at sites that had and had not introduced topical dexamethasone during the later period. Analyses were conducted both on infants with severe ROP and on all included infants. The difference-in-differences statistical method was used.

MAIN OUTCOME MEASURES: The proportion of infants that required traditional ROP treatment in each group and the interaction odds ratio, adjusted for potential confounding factors.

RESULTS: At the intervention site, the incidence of traditional ROP treatment fell from 23/32 (72%) to 4/32 infants (13%; P < 0.001) with severe ROP and from 23/409 (5.6%) to 4/217 screened infants (1.8%; P = 0.03). For the 3 control sites, the equivalent numbers were from 82/175 (47%) to 32/57 infants (56%; P = 0.22) and from 82/950 (8.6%) to 32/441 infants (7.3%; P = 0.38). The difference-in-differences analyses resulted in an adjusted interaction odds ratio of 0.05 (95% confidence interval, 0.01-0.22; P < 0.001) for infants with severe ROP, suggesting a markedly larger decline in occurrence of traditional ROP treatments at the intervention site.

CONCLUSIONS: In this population of infants with severe ROP, the introduction of dexamethasone eye drops was associated with a significant reduction in the proportion of infants requiring traditional ROP treatments. 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. Further studies are needed to confirm our findings.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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Contribution to journal
publication status
published
subject
keywords
Female, Humans, Infant, Newborn, Male, Angiogenesis Inhibitors/therapeutic use, Dexamethasone/administration & dosage, Disease Progression, Gestational Age, Glucocorticoids/administration & dosage, Incidence, Infant, Premature, Intravitreal Injections, Laser Coagulation, Ophthalmic Solutions/administration & dosage, Registries, Retinopathy of Prematurity/drug therapy, Sweden/epidemiology, Vascular Endothelial Growth Factor A/antagonists & inhibitors
in
Ophthalmology
volume
133
issue
2
pages
9 pages
publisher
Elsevier
external identifiers
  • scopus:105025043870
  • pmid:41038455
ISSN
1549-4713
DOI
10.1016/j.ophtha.2025.09.020
language
English
LU publication?
yes
id
ec5c7728-e1dd-4f7f-a3fe-221be06d7f6e
date added to LUP
2026-03-09 09:11:29
date last changed
2026-04-21 13:47:06
@article{ec5c7728-e1dd-4f7f-a3fe-221be06d7f6e,
  abstract     = {{<p>PURPOSE: To estimate the effect of dexamethasone eye drops on the risk of progression from type 2 retinopathy of prematurity (ROP) to ROP requiring traditional treatments.</p><p>DESIGN: Register-based cohort study.</p><p>PARTICIPANTS: Preterm infants born before 30 weeks' gestation from 2015-2018 (control years) and from 2020-2021 (intervention years) registered in the Swedish Quality Register for ROP at 4 Swedish sites were included. In 1 of these sites, the intervention site, topical dexamethasone was introduced during the later period when type 2 ROP was diagnosed.</p><p>METHODS: The frequency of traditional ROP treatments (laser ablation or intravitreal injection of anti-VEGF) was compared between the 2 periods at sites that had and had not introduced topical dexamethasone during the later period. Analyses were conducted both on infants with severe ROP and on all included infants. The difference-in-differences statistical method was used.</p><p>MAIN OUTCOME MEASURES: The proportion of infants that required traditional ROP treatment in each group and the interaction odds ratio, adjusted for potential confounding factors.</p><p>RESULTS: At the intervention site, the incidence of traditional ROP treatment fell from 23/32 (72%) to 4/32 infants (13%; P &lt; 0.001) with severe ROP and from 23/409 (5.6%) to 4/217 screened infants (1.8%; P = 0.03). For the 3 control sites, the equivalent numbers were from 82/175 (47%) to 32/57 infants (56%; P = 0.22) and from 82/950 (8.6%) to 32/441 infants (7.3%; P = 0.38). The difference-in-differences analyses resulted in an adjusted interaction odds ratio of 0.05 (95% confidence interval, 0.01-0.22; P &lt; 0.001) for infants with severe ROP, suggesting a markedly larger decline in occurrence of traditional ROP treatments at the intervention site.</p><p>CONCLUSIONS: In this population of infants with severe ROP, the introduction of dexamethasone eye drops was associated with a significant reduction in the proportion of infants requiring traditional ROP treatments. 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. Further studies are needed to confirm our findings.</p><p>FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>}},
  author       = {{Gränse, Lotta A K C and Öhnell, Hanna Maria V and Holmström, Gerd and Sundgren, Johanna C and Fahnehjelm, Kristina Teär and Wallin, Agneta and Larsson, Eva and Tsamadou, Despoina and Björklund, Lars J and Hellström, Ann and Wallander, Jenny and Hochhard, Karin Sandgren and Andreasson, Sten O L and Olhager, Elisabeth R and Björk, Jonas}},
  issn         = {{1549-4713}},
  keywords     = {{Female; Humans; Infant, Newborn; Male; Angiogenesis Inhibitors/therapeutic use; Dexamethasone/administration & dosage; Disease Progression; Gestational Age; Glucocorticoids/administration & dosage; Incidence; Infant, Premature; Intravitreal Injections; Laser Coagulation; Ophthalmic Solutions/administration & dosage; Registries; Retinopathy of Prematurity/drug therapy; Sweden/epidemiology; Vascular Endothelial Growth Factor A/antagonists & inhibitors}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{248--256}},
  publisher    = {{Elsevier}},
  series       = {{Ophthalmology}},
  title        = {{Treating Retinopathy of Prematurity with Dexamethasone Eye Drops : A Difference-in-Differences Study in Sweden Using Register Data}},
  url          = {{http://dx.doi.org/10.1016/j.ophtha.2025.09.020}},
  doi          = {{10.1016/j.ophtha.2025.09.020}},
  volume       = {{133}},
  year         = {{2026}},
}