Intravitreal VEGF blockade agents vs PRP for cases of PDR

Retinal Debate about the utilization of intravitreal VEGF blockade agents vs PRP for cases of PDR

In this webinar Mayssam Haykalliya will debate the use of intravitreal VEGF blockade agents for PDR vs Dr. Zeina Al junaidi, MD, FICO, ABO, SBO which will debate the use of PRP for PDR. As Ameen Marashi, MD, SBO will give the final verdict of rational utilization of the commercially available VEGF blockade agents and PRP. Dr. Ameen will host Dr Noura Almansoori, which is an Emirati consultant ophthalmologist specializing in medical retina and vitreoretinal surgeries. As she will share her experience with VEGF blockade agents and PRP utilization for PDR.

Each talk in this presentation is about five to seven minutes only 

The verdict by Ameen Marashi in the rational use of intravitreal AntiVEGF vs PRP for PDR

Dr.Ameen Marashi (born December 9, 1983) is a Syrian ophthalmologist and retina specialist.He has published a number of books and research articles in the field of retina and is the Al-Marashi Clinics Group owner.He graduated with a Diploma degree in Medicine from the Chuvash State University Institute of Medicine in 2008, and a certificate from the International Council of Ophthalmology in 2013, and completed a specialization in ophthalmology in Tartous Hospitals in 2009, and from 2010 until 2013 in Aleppo, and obtained a certificate Syrian Board 2016.

Meeting Summary 

For intravitreal AntiVEGF round: 

A major breakthrough in the treatment of PDR has been the development of anti-VEGF medications. Studies have shown that anti-VEGF can be used in conjunction with PRP, if not instead of it. 

In most studies, anti-VEGF results in improved VA gains and a significant reduction in CST. Anti-VEGF treatment has the additional advantage of regressing PDR back to NPDR more quickly in treated eyes. Due to the fact that anti-VEGFs can reduce the severity of DR, especially when DME coexists. Still, it remains to be seen whether anti-VEGF is better than PRP. Ophthalmologists in developing countries have been faced with this dilemma constantly. A patient's best treatment must take into account cost, compliance, and practicality.

For PRP round: 

Every patient is a distinct case think of the patient’s lifestyle and examination statutes before making a decision

PRP is still a mainstay treatment for vitreous hemorrhage, patients who can’t follow up, pregnancy, and patients at high risk of cardio-cerebral vascular events. Always consider the chance of endophthalmitis and retinal detachment in every injection along with the increased cost burden on the patient.

For expert opinion round:  Always think about the patient as a whole person

•Keep in mind different aspects of the DM

•Keep this as a checklist for you to tailor your treatment and

•Provide the best treatment for your patient

•Patient Condition

•Fundus exam

•Lens condition

•Iris rubeosis

•Insurance coverage.

•Access to medications

•Access to laser

•THE CONDITION OF THE OTHER EYE

For verdict round: 

• PRP is a mainstay treatment for cases of very severe NPDR and early PDR without DME and in cases that are contraindicated to Anti-VEGF injections.

• PRP is more durable and cost-effective. 

• PRP must be applied in cases of vitreous hemorrhage and rubeosis iridis.

• In cases of high-risk PDR adding an intravitreal injection of Anti-VEGF will reduce the need for aggressive PRP with rapid regression of PDR.

• In cases of PDR combined with DME, adding the intravitreal injection of VEGF will help to manage both proliferative changes and DME. 

• Always consider adding PRP when treating PDR with Anti-VEGF, especially in patients with compliance issues. 

• Intravitreal injection of Anti-VEGF will have rapid regression of PDR but it has a cost burden and the need for close follow up

• Intravitreal injection of Anti-VEGF requires multiple injections annually.