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Evidence mounts to support anti-VEGF to treat, prevent proliferative diabetic retinopathy

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Michael S. Ip

WAILEA, Hawaii — The current algorithm for the treatment of proliferative diabetic retinopathy is effective but is an inherently destructive treatment, according to Michael S. Ip, MD. The question is whether there is an effective alternative to use in place of panretinal photocoagulation.

“Our recent algorithm for proliferative diabetic retinopathy is to wait and watch this severity scale progress until frank neovascularization occurs and then we do something about it,” Ip said at Retina 2018. Whereas the use of panretinal photocoagulation (PRP) is effective, reducing risk of severe vision loss by 50%, there is mounting evidence to support anti-VEGF as an effective treatment for PDR, Ip said.

In the DRCR.net Protocol S trial, ranibizumab with deferred PRP was deemed noninferior to prompt PRP for treatment of proliferative diabetic retinopathy (PDR).

“This shows that perhaps, in some cases, we can replace PRP with injection of intravitreal ranibizumab or anti-VEGF therapy,” he said.

In the U.K.-based CLARITY trial, the adjusted difference in mean best corrected visual acuity was both noninferior and superior with aflibercept therapy compared with PRP at week 52 in patients with active PDR, Ip reported.

Regarding when to intervene to prevent PDR in the first place, “Thankfully we have some idea,” Ip said.

Because baseline level of retinopathy dictates risk for proliferative disease development, Ip suggested that intervention be based on that risk.

“Not only do we know which eyes are at highest risk, but we also know what eyes have the best response,” he said, citing RIDE/RISE results that showed more than 75% of ranibizumab-treated patients with moderately severe or severe nonproliferative diabetic retinopathy at baseline had a two-step or greater improvement in diabetic retinopathy severity.

The PANORAMA study and the DRCR.net Protocol W trial are both underway and will elaborate those findings, he said.

“It will be good to have good, evidence-based data to show that we should be evaluating and thinking about our patients with severe non-PDR, no diabetic macular edema and good visual acuity, and considering anti-VEGF for those patients,” he said. – by Patricia Nale, ELS

Reference:

Ip MS. An evidence-based approach intraoperative and perioperative OCT. Presented at: Retina 2018; Jan. 14-19, 2018; Wailea, Hawaii.

Disclosure: Ip reports he is a consultant for Allergan, Boehringer Ingelheim, Genentech, Omeros, Quark and ThromboGenics.