Intravitreal anti-vascular endothelial growth factor versus panretinal LASER photocoagulation for proliferative diabetic retinopathy: a systematic review and meta-analysis

Objective: To systematically review and perform a meta-analysis on the available evidence for anti-vascular endothelial growth factor (anti-VEGF) monotherapy versus panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR). Design: Systematic review and meta-analysis Participants: Randomized clinical trials included participants >= 18 years old with clinical or angiographic evidence of PDR. Interventions included were anti-VEGF monotherapy and PRP. Excluded studies were those with potentially biased treatment allocation and those offering combination therapies. Methods: The primary outcome was mean change in best-corrected visual acuity. Secondary outcomes were the proportion of patients developing severe (<6/60) or moderate (6/24-6/60) vision loss, rates of vitrectomy or vitreous hemorrhage, worsening macula edema, and reduced visual field indices. Results: Five studies of varying quality met the inclusion criteria (n = 632). The anti-VEGF intervention arm had a mean difference of -0.08 logMAR or 4 Early Treatment Diabetic Retinopathy Study (EDTRS) letters gained (p = 0.02) when compared with PRP at 12 months. The difference in rates of vitrectomy and vitreous hemorrhage favoured anti-VEGF over PRP (risk difference [RD] -0.10, p = < 0.001 and RD -0.10, p = 0.003 respectively). Conclusions: This meta-analysis of the available evidence in patients with early PDR demonstrates a potential benefit for anti-VEGF over PRP alone. However, these benefits must be weighed against the relative costs of treatment and the potential risks of loss to follow-up.

Automated summary

This meta-analysis of available evidence suggests a potential benefit of anti-VEGF over PRP for early PDR patients, but these benefits need to be balanced against treatment costs and risks of loss to follow-up.