Anti-VEGF Injections vs. Panretinal Photocoagulation Laser Therapy for Proliferative Diabetic Retinopathy: A...

Area of Science:

• Ophthalmology
• Diabetology
• Medical Retina

Background:

• Proliferative diabetic retinopathy (PDR) is a leading cause of blindness in working-aged adults globally.
• Current treatment strategies for PDR lack a definitive consensus on the optimal approach.
• Anti-vascular endothelial growth factor (anti-VEGF) therapy and panretinal photocoagulation (PRP) are primary treatment modalities.

Purpose of the Study:

• To systematically evaluate and compare the efficacy and safety of anti-VEGF therapy and PRP for PDR treatment.
• To analyze outcomes including best-corrected visual acuity (BCVA), neovascularization (NV), central macular thickness (CMT), and adverse events.
• To provide evidence-based insights for clinical decision-making in PDR management.

Main Methods:

• A comprehensive systematic review and meta-analysis was conducted, searching multiple databases (Cochrane, Embase, PubMed, Scopus, Web of Science, CiNAHL) up to June 2023.
• Included studies were randomized controlled trials (RCTs) comparing anti-VEGF, PRP, or combination therapy in PDR patients.
• Risk of bias and certainty of evidence were assessed using the Rob2 and GRADE approaches, respectively.

Main Results:

• Anti-VEGF therapy demonstrated superior BCVA outcomes compared to PRP at 3 and 12 months.
• Combination therapy also showed improved BCVA over PRP at 12 months and reduced CMT at 3 and 6 months.
• Anti-VEGF treatment was associated with a higher likelihood of complete neovascularization regression compared to PRP.

Conclusions:

• Anti-VEGF and combination treatments represent viable alternatives to sole PRP for PDR management, supporting shared decision-making.
• Treatment choice should consider patient adherence, diabetic macular edema status, and individual preferences.
• Further long-term RCTs are warranted to definitively compare the effectiveness of these therapeutic strategies.