Why substantial evidence is lacking to indicate either therapy method's preference for the treatment of neovascularization.
When treating neovascularization, is there a preference between anti-vascular endothelial growth factor (anti-VEGF) or pan retinal photocoagulation (PRP)? There's no clear answer, especially as indicated in the recent research by Hossein Ameri, MD, PhD. The assistant professor of clinical ophthalmology at the Keck School of Medicine of USC presented new data at the American Society of Retina Specialists (ASRS) Annual Meeting in Vancouver, BC this week that compared visual outcomes in patients with neovascular glaucoma (NVG) to that of patients with anterior segment neovascularization without glaucoma (ASNV).
Both patient groups were treated with either anti-VEGF intravitreal bevacizumab or PRP, or both. Though the pair of therapies have distinctions between them, it's too complex and clinically-lacking to give either an advantage.
Hossein Ameri, MD, PhD: Regarding whether PRP or anti-VEGF—bevacizumab in this case, because it's an off-label treatment—has any superiority and which one of these treatment we have to implement, really there is no clear data. Although, we saw in our patients that those who receive PRP were a little bit better, but it's not at the level that we would come up with the conclusion to use PRP versus anti-VEGF.
In this case, our recommendation would be to treat the patient aggressively on day 1, perhaps with both anti-VEGF and PRP. What is known is that these patients should receive full PRP.
Whether in the meantime, the treatment with anti-VEGF would help or not—that's something that would remain to be known. We could not extrapolate that from our study, but I do believe that anti-VEGF, in the earliest stage, it does help.
Because the effects of laser treatment—it takes a couple months to become evident, and in the meantime, using anti-VEGF early in the disease can help with the progression of new vessels in the earlier stage and better control of intraocular pressure.
Of course, if they are in advanced stage even with the regression of new vessels, still there is going to be fibrosis and peripheral anterior synechiae, and the intraocular pressure may not improve. But in those that are at the very earliest stages of anterior segment vascularization, that would probably help. And I do believe, probably, that in patients that have interminable procession without glaucoma, it would help even more.
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