Comparison of Intravitreal Antivascular Endothelial Growth Factor Therapy in Treatment-Naïve vs Panretinal Photocoagulation–Treated Eyes With Proliferative Diabetic Retinopathy

Purpose: To compare the effectiveness of antivascular endothelial growth factor (anti-VEGF) therapy with or without panretinal photocoagulation (PRP) on retinal neovascularization (NV) in patients with proliferative diabetic retinopathy (PDR) at 24 months. Methods: This retrospective, multicenter, observational case series included 237 patients (307 eyes) with retinal NV secondary to PDR treated with anti-VEGF. Results: Eyes were divided into 2 groups: eyes with prior PRP (group A, 162 eyes) and treatment-naïve eyes (group B, 145 eyes). Group A received a mean of 4.5 anti-VEGF injections per eye (95% CI, 4.1-5.1) and group B a mean of 5.8 (95% CI, 5.3-6.3) during follow-up. Both groups showed significant improvements in best-corrected visual acuity and central macular thickness. Mean visual acuity in group A improved from 20/125 to 20/60 ( P < .001) and in group B from 20/100 to 20/60 ( P = .002). Mean central macular thickness decreased in group A from 341.8 µm (95% CI, 327.2-358.1) to 285.3 µm (95% CI, 273.2-296.4; P < .001) and in group B from 346.1 µm (95% CI, 322.6-365.5) to 298.1 µm (95% CI, 276.2-319.1; P < .001). In group A, 127 eyes (78.4%) responded to anti-VEGF alone. In group B, only 23 eyes (15.8%) achieved complete or partial regression with anti-VEGF alone, while 122 (84.1%) required additional PRP or vitrectomy. Pars plana vitrectomy was performed in 6.7% of group A eyes and 12.4% of group B eyes. Main indications were vitreous hemorrhage and tractional retinal detachment in both groups. Conclusions: Antiangiogenic therapy resulted in marked regression of retinal NV in patients with PDR and previous PRP. A combined approach of antiangiogenics plus PRP should be studied.