Effectiveness of Panretinal Photocoagulation Plus Intravitreal Anti-VEGF Treatment Against PRP Alone for Diabetic Retinopathy: A Systematic Review With Meta-Analysis

Abstract

ObjectiveTo compare the efficacy and safety of panretinal photocoagulation (PRP) combined with intravitreal anti-vascular endothelial growth factor (anti-VEGF) against PRP monotherapy for diabetic retinopathy (DR).MethodsWe searched Pubmed, Cochrane Library, Web of Science, Embase, and Science Direct Register of Controlled Trials from April 2011 to January 2021 to identify the randomized trials that compared the efficacy and safety between PRP combined with intravitreal anti-VEGF and PRP monotherapy for DR. We searched in the following databases between April 2011 and January 2021: Pubmed, Cochrane Library, Web of Science, Embase, and Science Direct without any restriction of countries or article type. The outcome measures were the best-corrected visual acuity (BCVA), neovascularization on the disc (NVD), neovascularization elsewhere (NVE), central macula thickness (CMT), and total retinal volume over time (FAS), and we also observed the adverse events (AEs) between the two groups.ResultsA total of 351 studies were identified, of which 11 studies were included in this meta-analysis (N = 1,182 eyes). Compared with PRP monotherapy, PRP plus anti-VEGF combination treatment produced a mean reduction in BCVA in units of logMAR of -0.23 [95% CI -0.32, -0.15] or a mean improvement in BCVA in units of letters of 4.99 [95% CI 3.79, 6.19], and also yielded a mean reduction in NVD of -28.41 [95% CI -30.30, -26.52], in NVE of -1.33 [95% CI -1.52, -1.14], in CMT of -1.33 [95% CI -1.52, -1.14], or in total FAS. No significant difference was observed on the risk of AEs as vitreous hemorrhage, elevation in intraocular pressure, and cataract between the two different treatments.ConclusionPRP with anti-VEGF combination treatment can achieve the ideal efficacy on DR by improving BCVA and NV regression, with no potential increased incidence of AEs, which proves that the combination therapy is an efficient therapeutic strategy that could improve the management of patients with DR.

Effect of Chinese herbal compounds on ocular fundus signs and vision in conventional treated-persons with non-proliferative diabetic retinopathy: A systematic review and meta-analysis

“…Currently, calcium hydroxybenzenesulfonate is one of the most widely used drugs for the conventional treatment of NPDR in Western medicine, and its main mechanism may be to reduce retinal albumin leakage, reduce capillary permeability, inhibit oxidative stress and aldose reductase to protect retinal tissue, improve fundus microcirculation, and control the progression of NPDR ( 36 , 37 ). In recent years, retinal laser photocoagulation combined with vitreous cavity injection of anti-vascular endothelial growth factor and steroid hormone drugs has gradually become the first-line treatment option for DME ( 38 , 39 ) This has also effectively controlled the progression of NPDR to PDR, but the efficacy and safety of these conventional treatment options need to be further improved. Meanwhile, in long-term clinical practice, the efficacy of TCM in preventing and treating DR has been gradually recognized, and more and more scholars have tried to explore its specific mechanism of action and find high-quality evidence-based medical evidence.…”

“…In recent years, retinal laser photocoagulation combined with vitreous cavity injection of anti-vascular Forest plot of BCVA. endothelial growth factor and steroid hormone drugs has gradually become the first-line treatment option for DME (38,39) This has also effectively controlled the progression of NPDR to PDR, but the efficacy and safety of these conventional treatment options need to be further improved. Meanwhile, in long-term clinical practice, the efficacy of TCM in preventing and treating DR has been gradually recognized, and more and more scholars have tried to explore its specific mechanism of action and find high-quality evidence-based medical evidence.…”

Laser Treatment Modalities for Diabetic Retinopathy

“…And especially in the case of diabetes mellitus, it can also be associated with fibrosis, which will in turn increase the risk of traction retinal detachment [ 19 ]. Several studies have reported that anti-VEGF agents, if added to surgical interventions, will decrease the rate of formation of new vessels also known as neovascularization, and will also cause a decrease in bleeding and further complications, and for vitreous hemorrhage, it should be followed by endo-laser [ 20 ].…”

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

“… 47 The combination of PRP and anti-VEGF therapy has also demonstrated improvement in BCVA (reduction in units of logMAR of −0.23) and in mean neovascularisation on the disc (−28.41) as established from a meta-analysis. 48 …”

“…47 The combination of PRP and anti-VEGF therapy has also demonstrated improvement in BCVA (reduction in units of logMAR of −0.23) and in mean neovascularisation on the disc (−28.41) as established from a meta-analysis. 48 Protocol T shows a significant improvement in diabetic retinopathy severity score (DRSS) in the aflibercept group over a period of 12 months. 49,50 It was also reported to have a longer duration of action in comparison to other anti-VEGF agents.…”