For Treating Diabetic Retinopathy, Order Matters

TOPLINE:

In patients with proliferative diabetic retinopathy (PDR), treatment with panretinal photocoagulation (PRP) followed by anti–vascular endothelial growth factor (anti-VEGF) appears to increase complications and the need for eye surgery compared with treatment with anti-VEGF followed by PRP.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to evaluate the optimal treatment sequence of PRP and anti-VEGF injections in patients with PDR.
• They included 2167 patients treated between January 2003 and January 2024 who received PRP followed by anti-VEGF and 1549 patients treated with anti-VEGF first.
• The primary outcome was pars plana vitrectomy.
• The secondary outcomes were the incidences of bleeding inside eyes and tractional retinal detachment (TRD).

TAKEAWAY:

• Among the propensity score–matched population (n = 1377 in each treatment group; mean age, 63 years), more patients who underwent PRP before anti-VEGF injections required pars plana vitrectomy compared with those treated with anti-VEGF injections first during the 5-year follow-up period (risk difference [RD], 8.93%; P < .001).
• More patients who received PRP before anti-VEGF injections experienced bleeding inside the eye (RD, 6.47%; P < .001) and TRD (RD, 4.31%; P < .001).
• Initial treatment with PRP was associated with higher rates of pars plana vitrectomy, bleeding, and TRD at all time periods (P < .001 for all).

IN PRACTICE:

“This study provided evidence for increased need for PPV, as well as development of VH [vitreous hemorrhage] and TRD, in patients with PDR treated with PRP first, then anti-VEGF injection, compared with matched patients treated with anti-VEGF first, then PRP,” the study authors wrote. “Further studies are needed to determine the optimal order, if any, for treatment of patients presenting with PDR,” they added.

SOURCE:

This study was led by Amer F. Alsoudi, MD, of the Department of Ophthalmology at Baylor College of Medicine, in Houston, and published online on August 29 in JAMA Ophthalmology.

LIMITATIONS:

The retrospective analysis could not establish causality. Other limitations included potential inaccuracies diagnosis and coding, the inability to distinguish between right and left eyes, and the lack of data on diabetic macular edema, the severity of PDR, and preexisting vitreous hemorrhage.

DISCLOSURES:

The study did not report any specific funding. One author reported serving on advisory boards and receiving personal fees outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.