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Protocol S evidence expands role of anti-VEGF in proliferative diabetic retinopathy, but laser still useful
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VIENNA — DRCR.net Protocol S has shown non-inferiority of ranibizumab to panretinal photocoagulation in the treatment of proliferative diabetic retinopathy, but laser still has a role, according to a speaker here.
“I still think both options are useful, and we should get the best of both,” Robert L. Avery, MD, said at the Advanced Retinal Therapy meeting.
Ten years ago, Avery was using anti-VEGF agents as an adjunct to panretinal photocoagulation (PRP) in patients with diabetic macular edema and difficult-to-treat vitreous hemorrhage and as an adjunct to surgery.
“That was based just on my own clinical observation, while now we have the evidence showing that ranibizumab provides significant improvement in all patients, also those without DME,” he said.
However, PRP still has advantages, primarily the long-lasting effect, requiring no additional treatment.
“That is very important for this population of patients. I personally put a lot of value in that long-term effect. In addition, the cost is less than ranibizumab, and there is no risk of endophthalmitis,” Avery said.
His recommendation is to start with anti-VEGF in all proliferative diabetic retinopathy cases to minimize development of DME, while applying a light amount of laser to the more peripheral, anterior PRP, where it does not affect the visual field.
“I am not going to turn out my laser. It is possible that in many patients a combination of both treatments might be advantageous,” he said. – by Michela Cimberle
Disclosure: Avery reports he is a consultant to Alcon, Alimera, Allergan, Bausch + Lomb, Genentech, Notal Vision, Novartis, QLT, Regeneron and Replenish.