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To the Editor In their Viewpoint, Gross and Glassman1 have concluded that intravitreal anti–vascular endothelial growth factor (anti-VEGF) is noninferior to panretinal photocoagulation (PRP) in the treatment of proliferative diabetic retinopathy (PDR). We have a few concerns about this approach of using anti-VEGF for PDR.
In the study by the Diabetic Retinopathy Clinical Research Network2 on which this Viewpoint is based, worsening of fibrosis was included as a failure criterion in the anti-VEGF group and PRP could be performed in such eyes at investigator discretion. The investigators reported that at least 12 eyes (6%) required secondary PRP in the anti-VEGF group, for which 8 PRP treatments were done during vitrectomy. However, the baseline characteristics, causes for vitrectomy, and final outcome of these eyes have not been separately analyzed.
Singh SR, Singh R. Panretinal Photocoagulation vs Anti–Vascular Endothelial Growth Factor for Proliferative Diabetic Retinopathy. JAMA Ophthalmol. 2016;134(6):715-716. doi:10.1001/jamaophthalmol.2016.0701