Long-term Effects of Anti-VEGF Therapy versus Panretinal Photocoagulation on Retinal Vessel Caliber in Eyes with Proliferative Diabetic Retinopathy.

PubMed ID: 40216022

Author(s): Shen S, Josic K, Pak JW, Meuer SM, Melia M, Domalpally A, Sun JK, Blodi B; DRCR Retina Network. Long-term Effects of Anti-VEGF Therapy versus Panretinal Photocoagulation on Retinal Vessel Caliber in Eyes with Proliferative Diabetic Retinopathy. Ophthalmol Retina. 2025 Apr 9:S2468-6530(25)00159-9. doi: 10.1016/j.oret.2025.03.027. Online ahead of print. PMID 40216022

Journal: Ophthalmology. Retina, Apr 2025

PURPOSE To evaluate the long-term effects of ranibizumab compared with panretinal photocoagulation (PRP) on retinal vasculature in eyes with proliferative diabetic retinopathy (PDR).

DESIGN Post hoc analysis of DRCR Retina Network Protocol S randomized clinical trial.

PARTICIPANTS Adults with type 1 or 2 diabetes and PDR in at least one eye.

METHODS Integrative Vessel Analysis (IVAN) software was used to measure Central Retinal Arteriole/Venular Equivalents (CRAE/CRVE) of vessels at 1 disc diameter from the optic nerve edge on fundus photographs at baseline, two and five years for study eyes randomized to ranibizumab or PRP treatment for PDR. Changes in CRAE and CRVE were analyzed using mixed linear regression models with multivariable adjustments.

MAIN OUTCOME MEASURES Mean change in CRAE and CRVE from baseline to two and five years.

RESULTS Data from 107 eyes (90 participants) in the ranibizumab (n = 48) and PRP group (n = 59) were analyzed. For the ranibizumab vs. PRP groups, CRAE decreased by a mean of 2 vs. 12 μm at 2 years [mean difference, 10 μm; 95% CI, (4 to 16); p = 0.003]; and 9 vs. 13 μm at 5 years [mean difference, 4 μm; 95% CI, (-2 to 10); p = 0.22]. CRVE decreased by 14 vs. 19 μm at 2 years [mean difference, 4 μm; 95% CI, (-3 to 11); p = 0.26] and 18 vs. 28 μm at 5 years [mean difference, 11 μm; 95% CI, (3 to 19); p = 0.01].

CONCLUSION In patients with PDR, CRAE and CRVE decreased in both the ranibizumab and PRP groups at 5 years, but the rates of change before and after 2 years may be different. In this subset of eyes from Protocol S, the greater reduction in CRAE in the PRP group was statistically significant at 2 years, but not at 5 years.