The following is a summary of “Impact of anti-VEGF treatment on development of proliferative diabetic retinopathy in routine clinical practice,” published in the May 2024 issue of Ophthalmology by Moshfeghi et al.

There have been multiple cases of patients with non-proliferative diabetic retinopathy (NPDR) developing proliferative diabetic retinopathy (PDR). The underlying cause behind this is the release of vascular endothelial growth factor (VEGF), which stimulates the growth of new, abnormal blood vessels.

Researchers conducted a retrospective study evaluating the impact of anti-VEGF treatment in slowing or preventing the development of PDR in patients with NPDR. 

They analyzed the electronic medical records from January 2013 to June 2019 of eyes with NPDR, without diabetic macular edema (DME), and prior anti-VEGF treatment. Eyes with anti-VEGF and/or laser treatment during the study before the development of PDR were included in the treated cohort and compared to those treated with laser only (anti-VEGF naïve cohort). The comparison was done using the Kaplan-Meier and Cox regression to study PDR development and baseline factors. 

The results showed that among eyes not treated with anti-VEGF, DME rates were 27.1%, 51.2%, and 60.6% for mild (n=70,050), moderate (n=39,116), and severe NPDR (n=10,692), respectively. Severe NPDR had the highest risk for PDR development over 48 months (HR 6.51, 6.47-6.55) for severe vs. mild NPDR and (HR 2.69, 2.65-2.72) for moderate vs. mild NPDR. Cumulative PDR incidence over 48 months was 7.9% (7.4%-8.3%), 20.9% (20.0%-21.7%), and 46.8% (44.4%-49.2%) for mild, moderate, and severe NPDR at baseline, respectively. In severe NPDR eyes, PDR rates after 48 months were 50.1% in treatment with laser (n=546, HR 0.8 [0.7-1.0]), 27.4% with anti-VEGF (n=923, HR 0.4 [0.4-0.5], and 25.6% with anti-VEGF plus laser (n=293, HR 0.5 [0.4-0.7]), compared to 49.9% with no treatment (n=8930).

Investigators concluded that DME and PDR rates rose as NPDR severity increased. About half of severe NPDR cases advanced to PDR within 4 years, but this risk was halved with anti-VEGF treatment versus no treatment.

Source: bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-024-03491-w