There is ongoing interest in the debate between laser panretinal photocoagultion vs anti VEGF injections for proliferative diabetic retinopathy.
"Ophthalmology" currently have an article in press which summarises characteristics for the groups in PRP vs ranibizumab (Lucentis) by DRCRNet group which is leading the research in this area.
The important studies so far have been:
1. Protocol S - DRCRNet. This showed that ranibizumab was non inferior to laser PRP at 2 years in terms of VA outcome and also showed some advantages including great VA improvement, less VF loss and reduced change of vision impairment, DME development and lower vitrectomy rates.
2. CLARITY (Lancet 2017 June) - This used aflibercept (Eylea) and showed that Eylea was non inferior and superior to PRP in PDR.
Currently in clinical practice the trend is still to treat patients with PRP. Often when PDR is confirmed anti VEGF injections may be initially given even in the absence of DME. However PRP is still widely regarded as a definitive measure. This is often related to the treatment burden of ongoing intravitreal injections particularly as the population that require aggressive treatment may have issues with compliance and follow up.
It will be interesting to see further studies showing the benefit of anti VEGF over PRP.
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