Anti-vascular endothelial growth factor (anti-VEGF) injections vs pan-retinal photocoagulation (PRP) laser therapy for proliferative diabetic retinopathy (PDR): a meta-analysis and systematic review

Abstract

Purpose : Pan-retinal photocoagulation remains the standard treatment for proliferative diabetic retinopathy (PDR), but, while effective, it can be associated with serious adverse effects. In recent years, anti-vascular endothelial growth factor (VEGF) therapy has been explored as a safer alternative for the treatment of PDR. This meta-analysis and systematic review aims to evaluate the efficacy and safety of anti-VEGF in comparison to PRP for the treatment of PDR.

Methods : Cochrane, Embase, PubMed, Scopus, Web of Science and CiNAHL were searched for articles from their inception to June 2023. Eligible studies met all the following inclusion criteria: 1) comparative studies of adult patients with PDR treated with anti-VEGF injections, PRP, or a combination of the two, and (2) reported best corrected visual acuity (BCVA), neovascularization (NV), or central macular thickness (CMT) as at least one of their primary outcomes.

Results : From 723 studies screened, 19 studies met the eligibility criteria, with a total of 1,361 patients (n eyes=1,788) who were treated for PDR with either anti-VEGF (n= 274), PRP (n= 482) or the combination of anti-VEGF and PRP (n= 320). Our results show more favorable BCVA outcomes with anti-VEGF alone compared to PRP alone at 3 months (n=303; I²=0%) and 12 months follow-up (n=302; I²=26%). BCVA outcomes were comparable at 24 months between anti-VEGF and PRP treatment groups. Combination treatment also showed better BCVA outcomes compared to PRP alone at 12 months follow-up (n=300; I²=0), however, BCVA results were comparable between the combination and PRP alone groups at 3 months follow-up. Combination treatments showed lower CMT at 3 months (n=322; I²= 25%) and 6 months (n=314; I²=85%) compared to the PRP only group, but CMT results were similar at 12 months. Complete regression of total neovascularization was more likely in the anti-VEGF group (n=111) compared to the PRP group (n=45) (OR=6.15; I²=80%) and comparable between the combination treatment group (n=41) and the PRP only group (n=16) (OR=4.30; I²=88%).

Conclusions : Anti-VEGF and combination treatments could be considered as alternative approaches to PRP alone in the management of PDR for select patients. Further randomized controlled studies should be conducted to compare the effectiveness of these treatments long term.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.