Anti-VEGF injections for proliferative diabetic retinopathy

Retinal specialists knew that this would be on the cards at some point, but managing proliferative diabetic retinopathy (PDR) with regular intravitreal injections is not standard practice in the UK. This is perhaps due to cost, service pressures, or the fear of non-attendance or service-initiated re-schedulings causing re-proliferation at the retina and subsequent complications such as vitreous haemorrhage or tractional retinal detachment.

This DRCR Network study compared standard laser treatment (panretinal photocoagulation) with intravitreal injections for the treatment of PDR, with circa 200 patients in each group, albeit with anti-VEGF injections permitted for macular oedema in the laser group, and over 30% of patients overall lost to follow-up by the 5-year time point. At five years, the results were fairly predictable: the injection group patients had 4 times as many injections, half the incidence of macular oedema, less visual field disruption, but equal visual acuity.

To my mind, the data do support the introduction of regular intravitreal therapy for a select few cases of PDR, but I imagine that uptake in the UK will be slow, for all of the above-mentioned reasons. The development of longer-acting injected agents may however catalyse the demise of PRP treatment!