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Published on: January 25, 2019
A review of anti-VEGF agents for proliferative diabetic retinopathy
P Osaadon1, X J Fagan2, T Lifshitz1
1Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Abstract:
Previous research has implicated vascular endothelial growth factor (VEGF) in the pathogenesis of diabetic retinopathy (DR). Although many studies reviewed the use of anti-VEGF for diabetic macular oedema, little has been written about the use of anti-VEGF for proliferative diabetic retinopathy (PDR). This study is a review of relevant publications dealing with the use of anti-VEGF for the treatment of PDR. The articles were identified through systematic searches of PUBMED and the Cochrane Central Register of Controlled Trials. At the end of each section, we summarized the level of evidence of the scientific literature. Off-label use of anti-VEGF agents was found to be beneficial in PDR, especially in cases with neovascular glaucoma, persistent vitreous haemorrhage, and before vitrectomy. The disadvantages of the use of anti-VEGF are its short-effect duration, causing tractional retinal detachment in cases with pre-existing pre-retinal fibrosis and endophthalmitis in rare cases. There is no conclusive evidence from large randomized trials regarding the efficacy of anti-VEGF treatment in PDR. However, numerous case series, sound biochemical mechanism of action, and increasing experience with using anti-VEGF drugs can be used to support the ongoing use of this treatment modality in selected patients.
Insights
Anti-vascular endothelial growth factor (VEGF) agents show promise for treating proliferative diabetic retinopathy (PDR), particularly in complex cases. While evidence from large trials is limited, existing data supports their use in selected PDR patients.
Area of Science:
- Ophthalmology
- Vascular Biology
- Retinal Diseases
Background:
- Diabetic retinopathy (DR) is a significant complication of diabetes, with proliferative diabetic retinopathy (PDR) representing an advanced stage.
- Vascular endothelial growth factor (VEGF) plays a key role in the pathogenesis of DR.
- While anti-VEGF therapies are established for diabetic macular edema, their application in PDR requires further elucidation.
Purpose of the Study:
- To review the existing literature on the use of anti-VEGF agents for the treatment of proliferative diabetic retinopathy (PDR).
- To evaluate the benefits and drawbacks of anti-VEGF therapy in managing PDR.
- To summarize the current level of evidence supporting anti-VEGF use in PDR.
Main Methods:
- Systematic literature search of PUBMED and the Cochrane Central Register of Controlled Trials.
- Inclusion of relevant publications focusing on anti-VEGF treatment for PDR.
- Summarization of the level of evidence for scientific literature at the end of each section.
Main Results:
- Off-label use of anti-VEGF agents demonstrated benefits in PDR, especially for neovascular glaucoma, persistent vitreous hemorrhage, and pre-vitrectomy management.
- Identified disadvantages include short duration of action, potential for tractional retinal detachment with pre-existing fibrosis, and rare cases of endophthalmitis.
- No conclusive evidence from large randomized trials exists for anti-VEGF efficacy in PDR.
Conclusions:
- Despite limited large-scale trial data, case series and mechanistic understanding support the use of anti-VEGF agents in selected PDR patients.
- Anti-VEGF therapy offers a valuable option for specific PDR complications and scenarios.
- Further research may be needed to establish definitive efficacy and optimal protocols for anti-VEGF treatment in PDR.
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