Related Experiment Video
Updated: Apr 3, 2026
An Ex Vivo Tissue Culture Model for Fibrovascular Complications in Proliferative Diabetic Retinopathy
Published on: January 25, 2019
ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR PROLIFERATIVE DIABETIC RETINOPATHY: A Systematic Review and
Matthew P Simunovic1, David A L Maberley
1*Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; †Oxford Eye Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom; ‡Moorfields Eye Hospital, London, United Kingdom; and §Department of Ophthalmology and Visual Science, University of British Columbia, Eye Care Centre, Vancouver General Hospital, Vancouver, BC, Canada.
Purpose:
To systematically review and perform meta-analysis on the available randomized controlled trial data for anti-vascular endothelial growth factor (anti-VEGF) agents in the management of proliferative diabetic retinopathy and its complications.
Methods:
The authors identified randomized controlled trials using anti-VEGF agents, either as stand-alone therapy or combined with other interventions, in the management of proliferative diabetic retinopathy. The primary outcome measures were change in best-corrected visual acuity and (in the context of vitrectomy) duration of surgery and postoperative vitreous hemorrhage. Secondary outcomes were change in central retinal thickness and (in the context of vitrectomy) intraoperative variables suggestive of complex surgery (retinal breaks, intraoperative bleeding, and endodiathermy applications). The quality of evidence for all outcomes was appraised using the GRADE criteria.
Results:
Twenty-two studies involving 1,397 subjects met the criteria for inclusion in this study. One study compared intravitreal ranibizumab with saline, one compared intravitreal pegaptanib to pan-retinal photocoagulation (PRP), one compared intravitreal bevacizumab to PRP, 3 compared combined intravitreal ranibizumab/PRP to PRP, 5 compared combined intravitreal bevacizumab/PRP to PRP alone, and 11 compared combined intravitreal bevacizumab/PPV to PPV alone. When used in conjunction with PRP, there is a high-quality evidence to suggest that intravitreal ranibizumab is associated with superior visual acuity and central retinal thickness outcomes at 3 months to 4 months. In the context of PPV, there is moderate quality evidence to suggest that preoperative intravitreal bevacizumab results in a significant reduction in the duration of surgery, fewer retinal breaks, less intraoperative bleeding, and fewer endodiathermy applications. Although there is evidence to suggest occurrence of early postoperative vitreous hemorrhage is reduced, the quality of evidence in support of this finding is low.
Conclusion:
The use of anti-VEGF agents before PRP results in superior functional and structural outcomes at 3 months to 4 months. The use of anti-VEGF agents before PPV results in decreased duration of surgery, fewer breaks, and less intra-operative bleeding. Although there is evidence for a decreased incidence of early postoperative vitreous hemorrhage, the quality of evidence is low. The available data therefore support the use of anti-VEGF agents as adjuncts to PRP and PPV in patients with complicated proliferative diabetic retinopathy primarily as a means of facilitating, and potentially minimizing the iatrogenic damage resulting from, these procedures.
Insights
Anti-vascular endothelial growth factor (anti-VEGF) agents improve outcomes for proliferative diabetic retinopathy. Used before pan-retinal photocoagulation (PRP) or vitrectomy (PPV), they enhance vision, reduce surgery time, and minimize complications.
Area of Science:
- Ophthalmology
- Diabetic Retinopathy Management
- Vascular Endothelial Growth Factor Inhibition
Background:
- Proliferative diabetic retinopathy (PDR) is a leading cause of vision loss.
- Anti-vascular endothelial growth factor (anti-VEGF) agents are increasingly used in managing retinal diseases.
- Evidence for anti-VEGF efficacy in PDR requires systematic evaluation.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs) of anti-VEGF agents in PDR management.
- To assess the impact of anti-VEGF agents on visual acuity, surgical outcomes, and structural changes.
Main Methods:
- Systematic review and meta-analysis of 22 RCTs involving 1,397 participants.
- Inclusion of studies using anti-VEGF agents as standalone or combined therapy.
- Primary outcomes: best-corrected visual acuity, surgery duration, postoperative vitreous hemorrhage. Secondary outcomes: central retinal thickness, intraoperative variables.
Main Results:
- High-quality evidence shows anti-VEGF with pan-retinal photocoagulation (PRP) improves visual acuity and reduces central retinal thickness.
- Moderate-quality evidence indicates anti-VEGF before vitrectomy (PPV) significantly reduces surgery duration, retinal breaks, and intraoperative bleeding.
- Low-quality evidence suggests a potential reduction in early postoperative vitreous hemorrhage.
Conclusions:
- Anti-VEGF agents as adjuncts to PRP and PPV improve functional and structural outcomes in PDR.
- Preoperative anti-VEGF facilitates procedures and may minimize iatrogenic damage.
- Further research is needed to confirm benefits for early postoperative vitreous hemorrhage.
More Related Videos
Related Concept Videos
01:24Regulation of Angiogenesis and Blood Supply
01:27Open Angle Glaucoma: Treatment
Drugs such as carbonic anhydrase inhibitors, α2- and...
01:18Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...
01:28Angle Closure Glaucoma: Treatment