Patients with proliferative diabetic retinopathy treated with panretinal photocoagulation monotherapy had higher rates of complications compared to those treated with anti-vascular endothelial growth factor therapy, according to a new study.

The retrospective cohort study analyzed data from 6,020 matched patients, showing that panretinal photocoagulation (PRP) monotherapy was associated with increased incidences of vitreous hemorrhage, tractional retinal detachment (TRD), and progression to pars plana vitrectomy (PPV) over a 5-year period. Conducted using the TriNetX electronic health records research network, the study included patients diagnosed with PDR between January and September 2023. The patients were divided into two groups based on their treatment: PRP monotherapy or anti-vascular endothelial growth factor (anti-VEGF) monotherapy. Propensity score matching was used to control for variables such as age, gender, race, hemoglobin A1c levels, and body mass index.

The study, published in JAMA Ophthalmology, found that after 5 years, 9% of patients treated with PRP required PPV compared to 8% of those treated with anti-VEGF. Additionally, PRP monotherapy was linked to higher rates of VH and TRD at 6 months, 1 year, 3 years, and 5 years follow-ups. The relative risk of VH at 5 years was 1.72 times higher in the PRP group, and the risk of TRD was 2.76 times higher compared to the anti-VEGF group.

These findings indicate that PRP monotherapy increases the risk of PDR complications more than anti-VEGF therapy. The study aligns with earlier clinical trials suggesting that anti-VEGF therapy might be a more effective treatment option for PDR. The study provides valuable insights for clinicians in managing diabetic retinopathy, highlighting the need for careful consideration of treatment options. Further research is needed to explore the mechanisms behind these differences and to evaluate the potential benefits of combined treatment approaches.

Full disclosures can be found in the study.