Gawęcki Maciej, Kiciński Krzysztof, Bianco Lorenzo, Battaglia Parodi Maurizio
Dobry Wzrok Ophthalmological Clinic, 80-822 Gdansk, Poland.
Department of Ophthalmology, Pomeranian Hospitals, 84-200 Wejherowo, Poland.
Diagnostics (Basel). 2023 Dec 22;14(1):31. doi: 10.3390/diagnostics14010031.
Proliferative diabetic retinopathy (PDR) poses a significant therapeutic problem that often results in severe visual loss. Panretinal photocoagulation (PRP) has long been a mainstay treatment for this condition. Conversely, intravitreal anti-VEGF therapy has served as an alternative treatment for PDR. This review aimed to evaluate the effects of PRP combined with anti-VEGF therapy on the regression of neovascularization (NV), including functional outcomes and incidence of complications. The MEDLINE database was searched for articles evaluating regression of NV using a combination of the following terms: "proliferative diabetic retinopathy", "anti-VEGF", "panretinal photocoagulation", and "combined treatment". The search yielded a total of 22 articles. The analysis of their results indicated PRP combined with ant-VEGF therapy as superior over PRP alone in the management of PDR. Combination treatment yields better and faster regression of NV and a lower incidence of serious complications, such as vitreous hemorrhage and the need for pars plana vitrectomy. Nevertheless, complete regression of NV is not achieved in a significant proportion of patients. Further research is needed to establish the most effective schedule for intravitreal injections as an adjunct to PRP. The current literature shows that in some cases, cessation of anti-VEGF injection in combination treatment for PDR can lead to relapse of NV.
增殖性糖尿病视网膜病变（PDR）带来了一个重大的治疗难题，常常导致严重的视力丧失。全视网膜光凝（PRP）长期以来一直是这种病症的主要治疗方法。相反，玻璃体内抗血管内皮生长因子（VEGF）治疗一直是PDR的替代治疗方法。本综述旨在评估PRP联合抗VEGF治疗对新生血管（NV）消退的影响，包括功能结局和并发症发生率。在MEDLINE数据库中搜索使用以下术语组合评估NV消退的文章：“增殖性糖尿病视网膜病变”、“抗VEGF”、“全视网膜光凝”和“联合治疗”。搜索共得到22篇文章。对其结果的分析表明，在PDR的治疗中，PRP联合抗VEGF治疗优于单纯PRP治疗。联合治疗能使NV更好、更快地消退，且严重并发症（如玻璃体积血和平部玻璃体切除术的需求）的发生率更低。然而，相当一部分患者并未实现NV的完全消退。需要进一步研究以确定作为PRP辅助手段的玻璃体内注射的最有效方案。当前文献表明，在某些情况下，PDR联合治疗中停止抗VEGF注射可导致NV复发。
