Abstract
Diabetic retinopathy is a complication of diabetes that is one of the top five causes of blindness in those over 50. The standard treatment is pan-retinal photocoagulation, which is effective but has established side effects. Anti-vascular endothelial growth factor (anti-VEGF) therapy becomes an alternative to avoid the side effects caused by laser therapy. This systematic review aims to know the effectiveness of anti-VEGF therapy compared to the pan-retinal photocoagulation laser therapy in patients with proliferative diabetic retinopathy. This review was carried out using a systematic review checklist on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The articles reviewed were randomized controlled trial articles that met the inclusion and exclusion criteria. Based on inclusion and exclusion criteria, six articles were selected from a total of 215. Patients who received anti-VEGF medication had better visual acuity (positive values), whereas patients who received laser therapy had poorer visual acuity (negative values). Those results are because the laser directs light towards the retina, damaging photoreceptors and retinal cells as well as reducing visual acuity. On the contrary, anti-VEGF prevents damage to retinal endothelial cells and blood leaks in the vitreous by decreasing VEGF expression and thus resulting in improved visual acuity. Anti-VEGF proved to be a more practical alternative therapy in improving visual acuity than pan-retinal photocoagulation for patients with proliferative diabetic retinopathy.
References
Adrian, D. (2017). Pengaruh anti-VEGF pada diabetic retinopathy. Cermin Dunia Kedokteran, 44(11), 809–813.
Ali, W., Abbasi, K. Z., & Raza, A. (2018). Panretinal photocoagulation plus intravitreal bevacizumab versus panretinal photocoagulation alone for proliferative diabetic retinopathy. Journal of the Collage of Physicians and Surgeons Pakistan, 28(12), 923–927.
Behl, T., & Kotwani, A. (2015). Exploring the various aspects of the pathological role of vascular endothelial growth factor (VEGF) in diabetic retinopathy. Pharmacological Research, 99, 137–148. https://doi.org/10.1016/j.phrs.2015.05.013
Bigelow, A., & Freeland, B. (2017). Type 2 diabetes care in the elderly. Journal for Nurse Practitioners, 13(3), 181–186. https://doi.org/10.1016/j.nurpra.2016.08.010
Bourne, R. R. A., Flaxman, S. R., Braithwaite, T., Cicinelli, M. V., Das, A., Jonas, J. B., Keeffe, J., Kempen, J., Leasher, J., Limburg, H., Naidoo, K., Pesudovs, K., Resnikoff, S., Silvester, A., Stevens, G. A., Tahhan, N., Wong, T., Taylor, H. R., Ackland, P., … Zheng, Y. (2017). Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. The Lancet Global Health, 5(9), e888–e897. https://doi.org/10.1016/S2214-109X(17)30293-0
Bourne, R. R. A., Steinmetz, J. D., Flaxman, S., Briant, P. S., Taylor, H. R., Resnikoff, S., Casson, R. J., Abdoli, A., Abu-Gharbieh, E., Afshin, A., Ahmadieh, H., Akalu, Y., Alamneh, A. A., Alemayehu, W., Alfaar, A. S., Alipour, V., Anbesu, E. W., Androudi, S., Arabloo, J., … Vos, T. (2021). Trends in prevalence of blindness and distance and near vision impairment over 30 years: An analysis for the Global Burden of Disease Study. The Lancet Global Health, 9(2), e130–e143. https://doi.org/10.1016/S2214-109X(20)30425-3
Bressler, S. B., Beaulieu, W. T., Glassman, A. R., Gross, J. G., Melia, M., Chen, E., Pavlica, M. R., & Jampol, L. M. (2018). Panretinal photocoagulation versus ranibizumab for proliferative diabetic retinopathy: Factors associated with vision and edema outcomes. Ophthalmology, 125(11), 1776–1783. https://doi.org/10.1016/j.ophtha.2018.04.039
Brinda, B. J., Viganego, F., Vo, T., Dolan, D., & Fradley, M. G. (2016). Anti-VEGF-induced hypertension: A review of pathophysiology and treatment options. Current Treatment Options in Cardiovascular Medicine, 18(5). https://doi.org/10.1007/s11936-016-0452-z
Çeliker, H., Bulut, A. E., & Şahin, Ö. (2017). Comparison of efficacy and side effects of multispot lasers and conventional lasers for diabetic retinopathy treatment. Turk Oftalmoloiji Dergisi, 47(1), 34–41. https://doi.org/10.4274/tjo.75032
Duh, E. J., Sun, J. K., & Stitt, A. W. (2017). Diabetic retinopathy: current understanding, mechanisms, and treatment strategies. JCI Insight, 2(14), 1–13. https://doi.org/10.1172/jci.insight.93751
Evans, J. R., Michelessi, M., & Virgili, G. (2014). Laser photocoagulation for proliferative diabetic retinopathy. Cochrane Database of Systematic Reviews, 2014(11). https://doi.org/10.1002/14651858.CD011234.pub2
Flaxman, S. R., Bourne, R. R. A., Resnikoff, S., Ackland, P., Braithwaite, T., Cicinelli, M. V., Das, A., Jonas, J. B., Keeffe, J., Kempen, J., Leasher, J., Limburg, H., Naidoo, K., Pesudovs, K., Silvester, A., Stevens, G. A., Tahhan, N., Wong, T., Taylor, H., … Zheng, Y. (2017). Global causes of blindness and distance vision impairment 1990–2020: A systematic review and meta-analysis. The Lancet Global Health, 5(12), e1221–e1234. https://doi.org/10.1016/S2214-109X(17)30393-5
Giuliari, G. P. (2012). Diabetic retinopathy : Current and new treatment options. Current Diabetes Reviews, 8(1), 32–41.
Gross, J. G., Glassman, A. R., Liu, D., Sun, J. K., Antoszyk, A. N., Baker, C. W., Bressler, N. M., Elman, M. J., Ferris, F. L., Gardner, T. W., Jampol, L. M., Martin, D. F., Melia, M., Stockdale, C. R., & Beck, R. W. (2018). Five-year outcomes of panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: A randomized clinical trial. JAMA Ophthalmology, 136(10), 1138–1148. https://doi.org/10.1001/jamaophthalmol.2018.3255
Grossniklaus, H. E., Nickerson, J. M., Edelhauser, H. F., Bergman, L. A. M. K., & Berglin, L. (2012). Anatomic alterations in aging and age-related diseases of the eye. Investigative Ophthalmology and Visual Science, 54(14). https://doi.org/10.1167/iovs.13-12711
Gupta, N., Mansoor, S., Sharma, A., Sapkal, A., Sheth, J., Falatoonzadeh, P., & Kuppermann, B. D. (2013). Diabetic retinopathy and VEGF. The Open Ophthalmology Journal, 7, 4–10.
Hua, W., Cao, S., Cui, J., & Maberley, D. (2013). Analysis of reasons for noncompliance with laser treatment in patients of diabetic retinopathy. Canadian Journal of Ophthalmology/Journal Canadien d’ophtalmologie, 48(2), 88–92. https://doi.org/10.1016/j.jcjo.2012.09.012
Kiziltoprak, H., Tekin, K., Inanc, M., & Goker, Y. S. (2019). Cataract in diabetes mellitus. World Journal of Diabetes, 10(3), 140–153. https://doi.org/10.4239/wjd.v10.i3.140
Lang, G. E., Liakopoulos, S., Vögeler, J., Weiß, C., Spital, G., Gamulescu, M. A., Lohmann, C., & Wiedemann, P. (2018). The relation study: Efficacy and safety of ranibizumab combined with laser photocoagulation treatment versus laser monotherapy in NPDR and PDR patients with diabetic macular oedema. Acta Ophthalmologica, 96(3), e377–e385. https://doi.org/10.1111/aos.13574
Lang, G. E., Stahl, A., Voegeler, J., Quiering, C., Lorenz, K., Spital, G., & Liakopoulos, S. (2019). Efficacy and safety of ranibizumab with or without panretinal laser photocoagulation versus laser photocoagulation alone in proliferative diabetic retinopathy – the PRIDE study. Acta Ophthalmologica, 1–10. https://doi.org/10.1111/aos.14312
Martinez-zapata, M., Martí-carvajal, A., Solà, I., Pijoán, J., Buil-calvo, J., Cordero, J., & Evans, J. (2014). Anti-vascular endothelial growth factor for proliferative diabetic retinopathy. The Cochrane Database of Systematic Reviews, 2014(11)
Nepomuceno, A. B., Takaki, E., Paes De Almeida, F. P., Peroni, R., Cardillo, J. A., Siqueira, R. C., Scott, I. U., Messias, A., & Jorge, R. (2013). A prospective randomized trial of intravitreal bevacizumab versus ranibizumab for the management of diabetic macular edema. American Journal of Ophthalmology, 156(3). https://doi.org/10.1016/j.ajo.2013.04.026
Osaadon, P., Fagan, X. J., Lifshitz, T., & Levy, J. (2014). A review of anti-VEGF agents for proliferative diabetic retinopathy. 510–520. https://doi.org/10.1038/eye.2014.13
Palanker, D., & Blumenkranz, M. S. (2012). Panretinal photocoagulation for proliferative diabetic retinopathy. American Journal of Ophthalmology, 153(4), 780–781. https://doi.org/10.1016/j.ajo.2012.01.001
Platt, S., & Bakri, S. (1949). Laser treatment of diabetic retinopathy. In Current Management of Diabetic Retinopathy. Elsevier Inc. https://doi.org/10.1016/B978-0-323-48452-7.00009-3
Pratheeshkumar, P., Budhraja, A., Son, Y. O., Wang, X., Zhang, Z., Ding, S., Wang, L., Hitron, A., Lee, J. C., Xu, M., Chen, G., Luo, J., & Shi, X. (2012). Quercetin inhibits angiogenesis mediated human prostate tumor growth by targeting VEGFR- 2 regulated AKT/mTOR/P70S6K signaling pathways. PLoS ONE, 7(10), 1–10. https://doi.org/10.1371/journal.pone.0047516
Salam, A., Mathew, R., & Sivaprasad, S. (2011). Treatment of proliferative diabetic retinopathy with anti-VEGF agents. Acta Ophthalmologica, 89(5), 405–411. https://doi.org/10.1111/j.1755-3768.2010.02079.x
Simo, R., Sundstrom, J.M., Antonetti, D.A. (2014). Ocular Anti-VEGF therapy for diabetic retinopathy: The role of VEGF in the pathogenesis of diabetic retinopathy. Diabetes Care 1, 37(4), 893-899. https://doi.org/10.2337/dc13-2022
Sivaprasad, S., Prevost, A. T., Vasconcelos, J. C., Riddell, A., Murphy, C., Kelly, J., Bainbridge, J., Tudor-Edwards, R., Hopkins, D., Hykin, P., Bhatnagar, A., Burton, B., Chakravarthy, U., Eleftheriadis, H., Empeslidis, T., Gale, R., George, S., Habib, M., Kelly, S., … Karia, N. (2017). Clinical efficacy of intravitreal aflibercept versus panretinal photocoagulation for best corrected visual acuity in patients with proliferative diabetic retinopathy at 52 weeks (CLARITY): A multicentre, single-blinded, randomised, controlled, phase 2b, n. The Lancet, 389(10085), 2193–2203. https://doi.org/10.1016/S0140-6736(17)31193-5
Teo, Z. L., Tham, Y. C., Yu, M., Chee, M. L., Rim, T. H., Cheung, N., Bikbov, M. M., Wang, Y. X., Tang, Y., Lu, Y., Wong, I. Y., Ting, D. S. W., Tan, G. S. W., Jonas, J. B., Sabanayagam, C., Wong, T. Y., & Cheng, C. Y. (2021). Global Prevalence of Diabetic Retinopathy and Projection of Burden through 2045: Systematic review and meta-analysis. Ophthalmology, 1–12. https://doi.org/10.1016/j.ophtha.2021.04.027
Thomas, R. L., Dunstan, F. D., Luzio, S. D., Chowdhury, S. R., North, R. V., Hale, S. L., Gibbins, R. L., & Owens, D. R. (2015). Prevalence of diabetic retinopathy within a national diabetic retinopathy screening service. British Journal of Ophthalmology, 99(1), 64–68. https://doi.org/10.1136/bjophthalmol-2013-304017
Wang, W., & Lo, A. C. Y. (2018). Diabetic retinopathy: Pathophysiology and treatments. International Journal of Molecular Sciences, 19(6). https://doi.org/10.3390/ijms19061816
Wells, J. A., Glassman, A. R., Ayala, A. R., Jampol, L. M., Aiello, L. P., Antoszyk, A. N., Arnold-Bush, B., Baker, C. W., Bressler, N. M., Browning, D. J., Elman, M. J., Ferris, F. L., Friedman, S. M., Melia, M., Pieramici, J., Sun, J. K., & Beck, R. W. (2015). Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. New England Journal of Medicine, 372(13), 1193–1203. https://doi.org/10.1056/NEJMoa1414264
Yuan, Y., Wen, Z., Guan, Y., Sun, Y., Yang, J., & Fan, X. (2014). The relationships between type 2 diabetic retinopathy and VEGF-634G/C and VEGF-460C/T polymorphisms in Han Chinese subjects. Journal of Diabetes and its Complications, 28(6), 785–790. https://doi.org/10.1016/j.jdiacomp.2014.08.003
Zhao, Y., & Singh, R. P. (2018). The role of anti-vascular endothelial growth factor (anti-VEGF) in the management of proliferative diabetic retinopathy. Drugs in Context, 7, 1–10. https://doi.org/10.7573/dic.212532
Zong, H., Ward, M., & Stitt, A. W. (2011). AGEs, RAGE, and diabetic retinopathy. Current Diabetes Reports, 11(4), 244–252. https://doi.org/10.1007/s11892-011-0198-7
Recommended Citation
Indrakila, Senyum; Imani, Namira Putri; Asaduddin, Aiman Hilmi; Karima, Muzakiya Lailatul; and Widjaja, Lygia Angelica
(2023)
"Evaluation of Anti-VEGF and Pan-Retinal Photocoagulation Laser Therapies in Proliferative Diabetic Retinopathy Patients: A Systematic Review,"
Pharmaceutical Sciences and Research: Vol. 10:
No.
2, Article 2.
DOI: 10.7454/psr.v10i2.1304
Available at:
https://scholarhub.ui.ac.id/psr/vol10/iss2/2
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