Impact of different treatment regimens on long-term prognosis in patients with proliferative diabetic retinopathy: a systematic review
- 1Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510060, Guangdong Province, China
- 2State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, Guangdong Province, China
- 3Department of Ophthalmology, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou 516000, Guangdong Province, China
Abstract
AIM: To evaluate the long-term prognostic outcomes associated with different treatment regimens for PDR, including panretinal photocoagulation (PRP), anti-vascular endothelial growth factor (anti-VEGF) therapy, vitrectomy, and combination approaches. METHODS: A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library from database inception through March 31, 2024, with manual supplementary screening extended to June 30, 2024. Randomized controlled trials (RCTs) and comparative observational studies that directly evaluated at least two treatment regimens with a minimum follow-up of 1y were included in the principal therapeutic synthesis; imaging, screening, epidemiologic, and disease-characterization studies were retained as contextual evidence. Owing to substantial clinical and methodological heterogeneity, findings were synthesized through structured narrative synthesis in accordance with SWiM guidance, with evidence certainty assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. RESULTS: The evidence base comprised 20 studies encompassing 8742 participants and 9521 eyes. Major comparative trials, interpreted as moderate-certainty evidence, indicated that anti-VEGF therapy (ranibizumab) and PRP achieved broadly comparable long-term visual acuity outcomes in selected trial populations receiving structured follow-up. Anti-VEGF therapy was associated with better visual field preservation and a lower cumulative incidence of vision-impairing diabetic macular edema (DME) compared with PRP [22% vs 38%; hazard ratio (HR) 0.4, 95%CI: 0.3–0.7]. Combination therapy (PRP plus ranibizumab) demonstrated favorable neovascular regression in selected small comparative studies, and perioperative anti-VEGF adjuncts improved intraoperative conditions and reduced early postoperative hemorrhage in vitrectomy-treated eyes. CONCLUSION: Anti-VEGF therapy and PRP may provide broadly comparable long-term visual acuity outcomes in selected PDR patients, though important differences exist in treatment burden, visual field preservation, and complication profiles. Treatment selection should be individualized according to DME status, vitreous hemorrhage, tractional or fibrovascular components, prior PRP, anticipated adherence, and healthcare accessibility, with long-term surveillance remaining essential given the chronic and progressive nature of PDR.
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BibTeX
@article{li2026impact,
title = {{Impact of different treatment regimens on long-term prognosis in patients with proliferative diabetic retinopathy: a systematic review}},
author = {Yu-Man Li and Feng Zhao and Wen-Tao Li and Ying Cui and Lei Xi},
journal = {International Journal of Ophthalmology},
year = {2026},
month = nov,
doi = {10.18240/ijo.2026.11.20},
url = {https://doi.org/10.18240/ijo.2026.11.20},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Impact of different treatment regimens on long-term prognosis in patients with proliferative diabetic retinopathy: a systematic review
AU - Yu-Man Li
AU - Feng Zhao
AU - Wen-Tao Li
AU - Ying Cui
AU - Lei Xi
PY - 2026
DA - 2026/11/02
JO - International Journal of Ophthalmology
DO - 10.18240/ijo.2026.11.20
UR - https://doi.org/10.18240/ijo.2026.11.20
AB - AIM: To evaluate the long-term prognostic outcomes associated with different treatment regimens for PDR, including panretinal photocoagulation (PRP), anti-vascular endothelial growth factor (anti-VEGF) therapy, vitrectomy, and combination approaches. METHODS: A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library from database inception through March 31, 2024, with manual supplementary screening extended to June 30, 2024. Randomized controlled trials (RCTs) and comparative observational studies that directly evaluated at least two treatment regimens with a minimum follow-up of 1y were included in the principal therapeutic synthesis; imaging, screening, epidemiologic, and disease-characterization studies were retained as contextual evidence. Owing to substantial clinical and methodological heterogeneity, findings were synthesized through structured narrative synthesis in accordance with SWiM guidance, with evidence certainty assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. RESULTS: The evidence base comprised 20 studies encompassing 8742 participants and 9521 eyes. Major comparative trials, interpreted as moderate-certainty evidence, indicated that anti-VEGF therapy (ranibizumab) and PRP achieved broadly comparable long-term visual acuity outcomes in selected trial populations receiving structured follow-up. Anti-VEGF therapy was associated with better visual field preservation and a lower cumulative incidence of vision-impairing diabetic macular edema (DME) compared with PRP [22% vs 38%; hazard ratio (HR) 0.4, 95%CI: 0.3–0.7]. Combination therapy (PRP plus ranibizumab) demonstrated favorable neovascular regression in selected small comparative studies, and perioperative anti-VEGF adjuncts improved intraoperative conditions and reduced early postoperative hemorrhage in vitrectomy-treated eyes. CONCLUSION: Anti-VEGF therapy and PRP may provide broadly comparable long-term visual acuity outcomes in selected PDR patients, though important differences exist in treatment burden, visual field preservation, and complication profiles. Treatment selection should be individualized according to DME status, vitreous hemorrhage, tractional or fibrovascular components, prior PRP, anticipated adherence, and healthcare accessibility, with long-term surveillance remaining essential given the chronic and progressive nature of PDR.
SN - 2222-3959
SN - 2227-4898
ER -