Panretinal Photocoagulation Versus Intravitreal Bevacizumab Versus a Proposed Modified Combination Therapy for Treatment of Proliferative Diabetic Retinopathy

Abstract

Purpose: To compare safety and therapeutic effect of three treatment protocols on patients with naive proliferative diabetic retinopathy.Methods: A total of 207 eyes with proliferative diabetic retinopathy were randomly divided into three groups: full panretinal photocoagulation group; intravitreal bevacizumab (IVB) group with four monthly IVB injections; and modified combination group with two bimonthly IVB injections and a modified laser therapy. The best-corrected visual acuity and area of neovascularization leakage were compared at 1-year follow-up.Results: The difference in final best-corrected visual acuity was not significant between the groups (P = 0.77). The modified combination group had the lowest final leakage area (P = 0.006). The difference in final mean deviation of visual field was not significant between IVB and modified combination groups (mean difference = 0.25, P = 0.23, 95% confidence interval, 0.12-1.38). There was no difference in rate of new-onset diabetic macular edema between IVB and modified combination groups (mean difference = 1.5%, P = 0.31, 95% confidence interval, 1.1-1.88). Mean of total IVB injections were 3.5, 7.4, and 6.2 for panretinal photocoagulation, IVB, and modified combination groups, respectively (P = 0.002). Patients in the IVB group underwent more visits (P = 0.001). In subgroup analysis, the difference in the final leakage area was significant for the eyes with diabetic macular edema (P = 0.005).Conclusion: A combination protocol of photocoagulation and IVB can be recommended for proliferative diabetic retinopathy, especially with baseline diabetic macular edema.

Treatment of Proliferative Diabetic Retinopathy in 2023

“…31 This study included 207 eyes and assessed visual acuity and areas of leakage from neovascularization (based on fluorescein angiography) at 1 year. 31 The combination therapy arm included a modified laser treatment applied only to the retina anterior to the equator. Final analyses showed no statistically significant difference in visual acuity between the 3 treatment arms (P = 0.77) and a smaller area of leakage in the combination treatment arm (P = 0.006).…”

“…Final analyses showed no statistically significant difference in visual acuity between the 3 treatment arms (P = 0.77) and a smaller area of leakage in the combination treatment arm (P = 0.006). 31 A smaller study with 40 eyes investigated the efficacy of conventional ETDRS PRP + IVT ranibizumab versus PASCAL PRP + IVT ranibizumab versus IVT ranibizumab alone for PDR. Outcomes measured included visual acuity, macular thickness, and retinal neovascularization using fluorescein angiography testing at 48 weeks.…”

“…Combination therapy with laser and anti-VEGF has also been studied for PDR. The CTPDR Study investigated PRP versus IVT bevacizumab versus combination therapy for the treatment of PDR 31 . This study included 207 eyes and assessed visual acuity and areas of leakage from neovascularization (based on fluorescein angiography) at 1 year 31 .…”

“…The CTPDR Study investigated PRP versus IVT bevacizumab versus combination therapy for the treatment of PDR 31 . This study included 207 eyes and assessed visual acuity and areas of leakage from neovascularization (based on fluorescein angiography) at 1 year 31 . The combination therapy arm included a modified laser treatment applied only to the retina anterior to the equator.…”

Novel biomarkers and therapeutic approaches for diabetic retinopathy and nephropathy: Recent progress and future perspectives

“…Several studies, such as RESTORE (65), VISTA and VIVID (66) study have shown that the emergence of anti-VEGF therapy led to significant clinical improvements compared to laser therapy alone. Besides, a recent randomized clinical trial observed that combination of intravitreal bevacizumab injections and laser photocoagulation was more effective in preventing neovascularization and ameliorating visual field than pan-retinal photocoagulation (PRP) or bevacizumab alone in PDR patients (67). The combined protocol reduced the adverse effects of full PRP and need fewer injections and visits, suggesting that for some high-risk patients, anti-VEGF combined with PRP therapy may be more helpful in delaying the progression and improving the adherence of injections in DR.…”