Is Macugen Better Than Panretinal Photocoagulation for Diabetic Retinopathy?

December 10, 2009

Dr. Randall Wong

A small study published in the BJO reports that Macugen (pegaptanib) may be superior than pan-retinal photocoagulation for the treatment of proliferative diabetic retinopathy. 20 patients with proliferative diabetic retinopathy were followed. 10 were treated with 6 injections of pegaptanib over 30 weeks and the rest were treated with pan-retinal photocoagulation.

Resolution of the proliferative phase of the disease was noted in all of the injection group versus only 2 patients in the laser group. There was also an improvement in the visual acuity compared to the laser group.

What does this mean? I am not sure that it is easy to compare the results, but it does indicate that anti-VEGF may have long-term implications for the treatment of proliferative diabetic retinopathy. Obviously more studies need to be completed, but clearly the possibility of an alternative treatment to PRP is intriguing.

Treating patients with PRP is not necessarily easy for the doc nor comfortable for the patient. The amount of destruction required to arrest the disease varies from patient to patient. While we are usually successful in preserving the central vision, the light-dark adaptation problems caused by destruction of the peripheral retina are not to be ignored.

The possibility of sustained release devices liberating anti-VEGF over a prolonged period is very exciting if we find this to be a suitable treatment to laser. I look forward to more developments.