LAUSR

PURPOSE To review the current literature on the management of proliferative diabetic retinopathy (PDR) and the challenges in the real-world setting. METHODS A review of the literature was performed on the therapeutic options for PDR, with a focus on the real-world data presented by the Pan-American Collaborative Retina Study Group (PACORES). RESULTS Data from clinical trials and previous literature has reported that intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is non-inferior to the gold standard panretinal photocoagulation (PRP) for treating PDR. However, PDR recurs rapidly following cessation of anti-VEGF therapy. This is especially important in the context of the diabetic population that is prone to loss to follow up. In a real-world, prospective study, patients with prior PRP followed by anti-VEGF therapy had higher rates of sustained PDR regression relative to anti-VEGF therapy alone. CONCLUSIONS Due to its transient therapeutic effect, anti-VEGF therapy in diabetic patients can present a risk of recurrent retinal neovascularization and progression of PDR if follow-up cannot be guaranteed. A combined paradigm with less aggressive, immediate PRP followed by anti-VEGF therapy should be considered in this population.