Efficacy and safety of pan retinal photocoagulation combined with intravitreal anti-VEGF agents for high-risk proliferative diabetic retinopathy: A systematic review and meta-analysis

Abstract

Background: High-risk proliferative diabetic retinopathy (HR-PDR) is the advanced stage of diabetic retinopathy progression with poor prior treatment efficacy and high rates of blindness. This meta-analysis aims to compare the efficacy and safety of pan retinal photocoagulation (PRP) combined with intravitreal anti-vascular endothelial growth factor (aVEGF) (PRP + aVEGF) versus PRP monotherapy in HR-PDR patients. Methods: A thorough search was performed through PubMed, Web of Science, EMBASE, and the Cochran Library from inception to December 18, 2022. Outcome measures included change in central macular thickness, best-corrected visual acuity, fluorescein angiography, incidence of undergoing vitrectomy, and adverse events during the follow-up period. Results: Eight studies (6 randomized controlled trials and 2 retrospective studies) with 375 eyes were included in this meta-analysis. There were no obvious differences in the changes of best-corrected visual acuity and fluorescein angiography between the PRP + aVEGF and PRP monotherapy groups. However, PRP + aVEGF group had a significant reduction in the change of central macula thickness (standard mean deviations = −1.44, 95%CI = −2.55 to −0.32, P = .01) and the rate of undergoing vitrectomy (odds ratio = 0.20, 95%CI = 0.05–0.83, P = .01). Additionally, the risks of vitreous hemorrhage and other complications were not significantly different between the 2 groups. Conclusion subsections: Our meta-analysis indicated that PRP + aVEGF might have potential benefits in the treatment of HR-PDR patients. However, given several limitations of this study, more research is needed to confirm our findings.

Insights Into Visual Rehabilitation: Pan-Retinal Photocoagulation for Proliferative Diabetic Retinopathy

“…Additionally, PRP has been widely used to treat neovascular proliferative diseases secondary to conditions such as sickle cell retinopathy and venous occlusive diseases, further demonstrating its efficacy in reducing retinal neovascularization [45]. Furthermore, PRP combined with intravitreal anti-VEGF agents has shown positive outcomes in treating high-risk PDR, as evidenced by various systematic reviews and meta-analyses [46]. While PRP is effective, it is essential to be aware of potential complications associated with the procedure, such as choroidal effusions, exudative retinal detachments, and macular edema [25].…”

“…PRP has been a longstanding treatment for PDR [53]. It effectively reduces oxygen demand in the retina and prevents new vessel development [46]. However, PRP has drawbacks, potentially leading to visual field deficits and night vision defects [40].…”

“…Anti-VEGF therapy offers practicality and cost-effectiveness, often resulting in better visual acuity outcomes and lower incidences of vitreous hemorrhage [54]. A systematic review and meta-analysis revealed that the combination of PRP and intravitreal anti-VEGF agents exhibits superior efficacy in delaying vision loss associated with DR and reducing the number of vessels [46]. Despite this, comprehensive evidence regarding the long-term impact of anti-VEGF compared to PRP and studies involving larger sample sizes is crucial for a more nuanced understanding [54].…”