Dados do Trabalho

Título

Long-Term Efficacy of Anti-VEGF vs PRP in Preventing Severe Complications in Proliferative Diabetic Retinopathy: A Meta-Analysis

Objetivo

Vitreous hemorrhage (VH) and tractional retinal detachment (TRD) are leading causes of severe vision loss in patients with proliferative diabetic retinopathy (PDR). Recent data suggest that anti-VEGF monotherapy may reduce the incidence of these complications, and consequently the rates of pars plana vitrectomy (PPV), compared to panretinal photocoagulation (PRP) in the long term. We aim to test this trend by performing a pairwise meta-analysis of studies comparing anti-VEGF therapy with PRP in patients with PDR.

Método

A systematic search of PubMed, Embase, and Cochrane was conducted up to August 2024 looking for studies comparing anti-VEGF with PRP for the treatment of PDR. Main outcomes of interest were rates of VH, TRD and PPV in the long run.Secondary outcomes included short-term rates of VH, TRD, PPV, changes in Best Corrected Visual Acuity (BCVA),changes in Central Macular Thickness (CMT), and Diabetic Macular Edema (DME) rates. To perform the meta-analysis we used R software with the metabin function inside the meta package.

Resultados

Eight studies were included, with a total of 12,939 eyes. Anti-VEGF therapy demonstrated short-term superiority over PRP in improving BCVA, CMT, and reducing rates of DME and VH. There was no difference in PPV rates (RR = 0.49; 95% CI [0.22, 1.08]; I² = 62%), though sub analysis with only Randomized Clinical Trials revealed benefits favoring anti-VEGF (RR = 0.34; 95% CI [0.16, 0.73]; I² = 13%). Long-term data indicated that anti-VEGF reduced TRD risk (RR = 0.31; 95% CI [0.23, 0.42]; I² = 20%), with a high certainty of evidence according to our GRADE assessment. Nonetheless, PPV results remained ambiguous, with no difference observed in the random effects model (RR = 0.75; 95% CI [0.53, 1.07]; I² = 57%). Additionally, the majority of TRD cases did not require surgery, as reported in the long-term results of Protocol S. We found no significant difference in long-term rates of VH (RR = 0.77; 95% CI [0.43, 1.38]; I² = 96%).The certainty of evidence for these outcome was rated low by our GRADE assessment, due to high heterogeneity and imprecision.

Conclusões

Our short-term results confirm trends from previous research, demonstrating the superiority of anti-VEGF over PRP across all major outcomes.Nonetheless, in the long term, while anti-VEGF shows a protective effect against TRD, the clinical significance of this finding is questionable, particularly due to the low severity of TRD cases and the lack of a significant difference in PPV rates.

Palavras Chave

Proliferative Diabetic Retinopathy (PDR), Anti-VEGF therapy, Panretinal Photocoagulation (PRP), Vitreous Hemorrhage (VH), Tractional Retinal Detachment (TRD), Pars Plana Vitrectomy (PPV), Visual Acuity, Diabetic Macular Edema (DME), Long-term outcomes, Meta-analysis