Anti-Vascular Endothelial Growth Factor Therapy as an Alternative or Adjunct to Pan-Retinal Photocoagulation in Treating Proliferative Diabetic Retinopathy: Meta-Analysis of Randomized Trials

Abstract

Aim: To compare anti-vascular growth factor (anti-VEGF) pharmacotherapy with panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR). Method: PubMed, Embase, Medline, the ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials were reviewed systemically. Randomized controlled trials (RCT) on anti-VEGF therapy versus PRP or anti-VEGF agent combined with PRP versus PRP for PDR are eligible to be included. Outcome measures were regression and recurrence of neovascularization, change in best corrected vision acuity, development of vitreous hemorrhage, and need for vitrectomy. A meta-analysis was conducted using RevMan (Cochrane Collaboration, Oxford, United Kingdom). Results: Twelve RCTs with a total of 1026 eyes were identified. The meta-analysis results showed that regression of neovascularization did not vary significantly among different treatment regimens (P=0.06), whereas the recurrence of new vessels was significantly lower in PRP monotherapy (P < 0.00001). The best corrected visual acuity was significantly improved with anti-VEGF monotherapy or in the combined group than in the PRP groups (P < 0.00001, P=0.04, respectively). Odds ratio for post-treatment vitreous hemorrhage and vitrectomy rate between anti-VEGF therapy and PRP were 0.65 (95% confidence interval, 0.45-0.95; P = 0.03), and 0.24 (95% confidence interval, 0.12-0.48; P < 0.0001). Conclusion: Our meta-analysis indicates that anti-VEGF pharmacotherapy is associated with superior visual acuity outcomes and less PDR-related complications. However, there is insufficient evidence to suggest anti-VEGF therapy as an alternative to PRP.

Management of acute proliferative diabetic retinopathy related complications during the first COVID-19 wave

“…The CLARITY study demonstrated the advantageous effect on visual outcome at one year with a lower incidence of vitreous haemorrhage following loading treatment with aflibercept for PDR over standard PRP treatment [ 7 ]. A meta-analysis by Gao et al demonstrated fewer PDR complications with the use of anti-VEGF when compared to PRP alone [ 37 ]. Through the use of OCTA (optical coherence tomography angiography), He et al suggested that combination PRP plus anti-VEGF treatment was more effective at regressing NVE than PRP alone [ 38 ].…”

Management of Acute Proliferative Diabetic Retinopathy Related Complications During the First COVID-19 Wave

“…The CLARITY study demonstrated the advantageous effect on visual outcome at one year with a lower incidence of vitreous haemorrhage following loading treatment with a ibercept for PDR over standard PRP treatment 22 . A meta-analysis by Gao et al demonstrated fewer PDR complications with the use of anti-VEGF when compared to PRP alone 23 . Through the use of OCTA (optical coherence tomography angiography), He et al suggested that combination PRP plus anti-VEGF treatment was more effective at regressing NVE than PRP alone 24 .…”

A Paradigm Shift in the Management Approaches of Proliferative Diabetic Retinopathy: Role of Anti-VEGF Therapy

“…54 There are other various pivotal global studies that established the effectiveness of anti-VEGF therapy. [56][57][58] Preoperative anti-VEGF injections have also been shown to decrease surgical time required, as well as being associated with reduced intraoperative bleeding. An IVB also helps in overcoming the complications of VH by minimising the need for PPV and decreasing vitreous clear-up time.…”