Which treatment modality offers the best outcomes for diabetic retinopathy? A systematic review and network meta-analysis
Authors' conclusion
Anti-VEGF therapies are more effective than PRP in improving visual acuity, reducing macular thickness, and controlling neovascularization in DR patients while exhibiting superior safety profiles. Combination therapy may offer added benefits in specific scenarios. These findings support anti-VEGF agents as first-line treatments for vision-threatening DR.
Study context
- Population
- Patients with diabetic retinopathy (DR) (proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME))
- Participants
- 6,450 patients28 randomized controlled trials (RCTs)
- Comparison
- Anti-VEGF agents vs panretinal photocoagulation (PRP) vs combination therapy
- Outcome
- Best-corrected visual acuity (BCVA) and central retinal thickness (CRT)
Methodological detailsBayesian network meta-analysis, Search of PubMed, Embase, Cochrane Library and trial registries up to February 2025
- Bayesian network meta-analysis
- Search of PubMed, Embase, Cochrane Library and trial registries up to February 2025
Pooled result
As reported in the abstract
12 months
Anti-VEGF vs PRPDifference, µm (95 % CI)
CRT reduction
−24.50(−39.03 to −9.97)
- Best-corrected visual acuity (BCVA) at 12 months
- mean difference +3.39 letters (95 % CI +1.85 to +4.93)
Further pooled results
| Outcome | OR |
|---|---|
| Neovascularization regressionAnti-VEGF vs PRP | 6.15 |
Central retinal thickness (CRT) reduction with combination therapy · 3 months
- Combination therapy provided additional benefits for CRT reduction
- −33.10 µm
Safety
- Anti-VEGF agents had fewer adverse events vs PRP, including lower rates of visual field loss and raised intraocular pressure
Original publication
Which treatment modality offers the best outcomes for diabetic retinopathy? A systematic review and network meta-analysis. Diabetes Res Clin Pract. Published 21 July 2025. doi:10.
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