Review of the latest treatments for proliferative diabetic retinopathy

Abstract

Chronic hyperglycemia leads to the development of the neurovascular disease known as diabetic retinopathy. Proliferative diabetic retinopathy (PDR) is the most advanced stage of diabetic retinopathy and is diagnosed with the onset of neovascularization (NV). Understanding the pathophysiology of NV and monitoring the disease using advanced diagnostic instruments is essential in providing timely treatment. While the standard treatment for PDR is panretinal photocoagulation, new pharmaceutical approaches, such as anti-VEGF treatments, may promote rapid regression of NV. Recent enhancements in vitrectomy techniques have improved post-operative recovery and overall surgical outcomes for the late complications of PDR. This article is a comprehensive review of the latest treatments for the management of PDR.

Keywords::

• anti-VEGF
• neovascularization
• panretinal photocoagulation
• proliferative diabetic retinopathy
• traction retinal detachment
• vascular endothelial growth factor
• vitrectomy
• vitreous hemorrhage

Financial & competing interests disclosure

JG Gross has received research support from Regeneron, Acucela, and Jaeb Center for Health Research, is a consultant for Thrombogenics and is a member of the executive committee for Jaeb Center for Health Research (Diabetes Clinical Research Network). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Anti-VEGF therapy is an important treatment for rapid regression of neovascularization. Long-term studies of intravitreal anti-VEGF therapy are needed to determine overall efficacy and safety.

• Due to the reoccurrence of neovascularization after intravitreal anti-VEGF, more effective therapeutic management and longer intervals between injections are desirable.

• Further investigation using anti-VEGF agents with deferred panretinal photocoagulation is needed to determine which treatment is best for long-term PDR management or if a combination is more effective.

• More sophisticated technologies for panretinal photocoagulation treatments will allow a decrease in the local adverse events related to the destructive use of panretinal photocoagulation with more comfortable and quicker laser application.

• Advances in smaller gauge vitrectomy instruments allow more precise delamination and removal of fibrovascular membranes and decrease wound healing time.