Meta-analysis: long/short-term efficacy of anti-VEGF vs. panretinal photocoagulation in preventing severe complications in proliferative diabetic retinopathy.

BACKGROUND

Studies diverge on the relevance of long-term protection of anti-VEGF against severe proliferative diabetic retinopathy (PDR) complications compared to pan-retinal photocoagulation (PRP). We aim to assess this dispute through a meta-analysis.

METHODS

We searched PubMed, Embase, and Cochrane databases until August 2024 for studies comparing anti-VEGF with PRP in PDR. Primary outcomes were long-term and short-term incidences of VH, TRD, and PPV-setting short-term follow-up up to 2 years and long-term follow-up over 5 years. Due to a lack of consistent data, TRD events were not stratified by clinical severity. We also evaluated diabetic macular edema (DME) rates and changes in best corrected visual acuity (BCVA) and central macular thickness (CMT). We used R to pool risk ratios (RR) and weighted mean differences with a random-effects model, and appraised evidence certainty using the GRADE tool. PROSPERO CRD42024577668.

RESULTS

We included eight studies with 12,812 eyes. Long-term data showed anti-VEGF reducing TRD (3.4% vs. 11.5%; RR 0.31, 95% CI 0.23-0.42; p = 0.001) with high certainty of evidence. However, PPV (7.8% vs. 9.4%; p = 0.116) and VH rates (11% vs. 18%; p = 0.38) did not differ, with moderate and low evidence certainty, respectively. In the short term, anti-VEGF demonstrated superiority in BCVA and CMT outcomes and reduced DME rates.

CONCLUSIONS

Although anti-VEGF was associated with lower TRD rates in the long term, the absence of severity data and the lack of differences in PPV and VH raise questions about its clinical relevance. Long-term findings are limited to only two studies. Future research should stratify TRD by severity and include extended follow-up. In contrast, short-term outcomes consistently favored anti-VEGF for both visual and anatomical results.