There are some limitations in the present study: 1) due to the nature of treatment for severe ROP, high-quality RCTs are lacking, more robust conclusions could be drawn if more RCTs were included; 2) significant variability was present in gestational age, follow-up ages, and anti-VEGF doses across the included studies, which might affect the refractive results among studies. Here, VEGFA is linked to retinopathy of prematurity.