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A. Chylak, A. Salam, S. Sivaprasad; Effectiveness of Anti-VEGF Agents in Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1373.
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To examine the effectiveness of Anti-VEGF in PDR
Systematic literature review of randomized controlled trials, prospective and retrospective open labelled, sham controlled and consecutive case series studies that evaluated the effect of Anti VEGF on PDR was done according to Cochrane Collaboration methodology.
12 studies involving a total of 256 eyes were included. There was only one retrospective analysis of Randomized controlled trial analysing the effect of Pegaptanib on PDR. There were no studies conducted to see the effect of Ranacizumab on PDR. Eleven trials examined the effectiveness of Bevacizumab in PDR. The primary end point in all studies was regression of new vessels shown by Fundus fluoroscein angiography (FFA), fundus photos, and changes in the best corrected visual acuity (ERDRS). Other end points included regression of the new vessels. The number of injections varied from 1 to 6. Pan retinal photocoagulation at or before VEG F treatment was done in nine studies. All studies showed regression of new vessels over a short term. Two studies showed rapid clearing of intra gel haemorrhages. Anti VEFG was well tolerated. Three studies showed recurrence of PDR from 12 weeks to 28 weeks post injection. Only two studies showed improvement in visual acuity by 0.17 ± 0.12 Logmar.
Intravitreal Anti-VEG F serves as a short term adjunct in reducing disease activity in most cases. It is a good interim treatment for patients awaiting vitrectomy for intragel haemorrhage. Well conducted randomized controlled trials with long term follow-up are essential to understand the modulation of the disease process caused by anti-VEGF agents.
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