In Reply Singh and Singh state that the development or worsening of TRD as a result of preretinal fibrosis is a potential complication of anti-VEGF therapy in the setting of PDR based on description from a few case series or retrospective reports. Eyes with PDR are inherently at risk for developing TRD or having preexisting TRD worsen and threaten detachment of the macula. There is evidence, however, that anti-VEGF therapy does not increase the risk of this complication. In several randomized clinical trials using anti-VEGF treatment in eyes with PDR in the setting of diabetic macular edema or vitreous hemorrhage,1- 3 rates of TRD have been similar or lower in the anti-VEGF group compared with a control group not receiving anti-VEGF therapy. In the current randomized clinical trial referenced by Singh and Singh, rates of TRD, rhegmatogenous retinal detachments, or combined tractional and rhegmatogenous retinal detachments were 6% in the anti-VEGF group and 10% in the PRP group.4 To our knowledge, there are no randomized clinical trials supporting the concern that anti-VEGF therapy for PDR is harmful. Although Singh and Singh raise the concern that eyes with PDR have the potential for severe vison loss with anti-VEGF use, severe vision loss did not occur at a higher rate in eyes assigned to ranibizumab compared with eyes assigned to PRP in the referenced study.
Gross JG, Glassman AR. Panretinal Photocoagulation vs Anti–Vascular Endothelial Growth Factor for Proliferative Diabetic Retinopathy—Reply. JAMA Ophthalmol. 2016;134(6):716. doi:10.1001/jamaophthalmol.2016.0703