Anti-VEGF a Safe Swap for Laser in Diabetic Retinopathy

TOPLINE:

In patients with proliferative diabetic retinopathy, treatment with anti–vascular endothelial growth factor (anti-VEGF) may offer a safer alternative to panretinal photocoagulation (PRP), leading to fewer complications and a reduced need for additional surgeries.

METHODOLOGY:

• Researchers performed a retrospective cohort study to compare the outcomes of PRP and anti-VEGF monotherapy in patients with proliferative diabetic retinopathy from January 2003 to September 2023.
• They evaluated 12,626 patients who received PRP only and 10,687 treated with anti-VEGF monotherapy.
• The patients were followed for 6 months and 1, 3, and 5 years.
• The primary outcome was pars plana vitrectomy.
• The secondary outcomes were the incidences of vitreous hemorrhage or tractional retinal detachment.

TAKEAWAY:

• Among the propensity-score matched population (n = 6020 in each treatment group), 9% of patients who underwent PRP monotherapy and 8% of those who received anti-VEGF agents underwent pars plana vitrectomy during the 5-year follow-up period.
• The risk for undergoing vitrectomy was higher in patients who received laser treatment alone at 1 (risk difference [RD], 0.86%; P = .03), 3 (RD, 1.03%; P = .03), and 5 years (RD, 1.37%; P 
• Laser treatment also was associated with higher risks for vitreous hemorrhage and tractional retinal detachment at all time periods (P 

IN PRACTICE:

“These findings suggest that PDR treated with PRP monotherapy had an increased relative risk to develop complications of PDR compared with matched patients treated with anti-VEGF monotherapy, although confounding factors could account for some of the associations,” the authors wrote.

SOURCE:

Amer F. Alsoudi, MD, of the Department of Ophthalmology at the Baylor College of Medicine, in Houston, led the study, which was published online on June 6, 2024, in JAMA Ophthalmology.

LIMITATIONS:

The authors acknowledged potential bias in treatment decisions and possibility of data errors in the medical records. The study did not exclude patients based on the presence of preexisting vitreous hemorrhage, which could have influenced the treatment outcomes.

DISCLOSURES:

The study did not declare any funding source. Some authors reported serving as consultants or lecturers and receiving stipends, personal fees, or financial support from various pharmaceutical companies.