Clinical Ophthalmology (Sep 2022)
A Paradigm Shift in the Management Approaches of Proliferative Diabetic Retinopathy: Role of Anti-VEGF Therapy
Abstract
Rajiv Raman,1 Kim Ramasamy,2 Utkarsh Shah3 1Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India; 2Aravind Eye Hospital, Madurai, Tamil Nadu, India; 3Novartis Healthcare Private Limited, Mumbai, IndiaCorrespondence: Rajiv Raman, Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India, Tel +91-9444288708, Email [email protected]: Diabetic retinopathy (DR) is considered one of the leading causes of vision loss globally. It principally causes upregulation of pro-angiogenic, proinflammatory, and vascular permeability factors such as vascular endothelial growth factor (VEGF), leading to neovascularisation. The advanced stage of DR or proliferative diabetic retinopathy (PDR) is of more concern, as it leads to vitreous haemorrhage and traction retinal detachment. Various risk factors associated with PDR include hyperglycemia, hypertension, neuropathy, dyslipidemia, anaemia, nephropathy, and retinal complications of drugs used for diabetes. Current management approaches for PDR have been stratified and involve pan-retinal photocoagulation, vitrectomy, and anti-VEGF agents. Given the emerging role of anti-VEGF agents as a favourable adjunct or alternative therapy, they have a critical role in the management of PDR. The review emphasises current management approaches for PDR focusing on anti-VEGF therapy. The review also highlights the risk/benefit evaluation of the various approaches employed for PDR management in various clinical scenarios.Keywords: neovascularisation, diabetic retinopathy, pan-retinal photocoagulation, vitrectomy, anti-VEGF, PDR in India
