From the Guidelines
Bevacizumab is more effective than laser photocoagulation for treating diabetic retinopathy, particularly for center-involved diabetic macular edema, as demonstrated by recent clinical trials 1. When considering treatment options for diabetic retinopathy, it's essential to weigh the benefits and risks of each approach.
- Bevacizumab, an intravitreal anti-VEGF agent, has been shown to provide better visual outcomes and more effective reduction of macular edema compared to traditional laser photocoagulation 1.
- The typical regimen involves near-monthly administration of intravitreal therapy with anti-VEGF agents during the first 12 months of treatment, with fewer injections needed in subsequent years to maintain remission from central-involved diabetic macular edema 1.
- While bevacizumab often provides faster vision improvement, it requires repeated injections and carries risks including eye infection, inflammation, and increased intraocular pressure.
- Laser therapy remains valuable for certain cases, such as eyes that have persistent diabetic macular edema despite anti-VEGF treatment, and may provide more durable results with fewer interventions over time 1.
- A comparative effectiveness study demonstrated that aflibercept provides vision outcomes superior to those of bevacizumab when eyes have moderate visual impairment (vision of 20/50 or worse) from diabetic macular edema 1.
- However, for eyes that have good vision (20/25 or better) despite diabetic macular edema, close monitoring with initiation of anti-VEGF therapy if vision worsens provides similar 2-year vision outcomes compared with immediate initiation of anti-VEGF therapy 1.
From the Research
Comparison of Bevacizumab and Laser Photocoagulation for Diabetic Retinopathy
- Bevacizumab has been shown to be more effective than laser photocoagulation in treating diabetic macular edema (DME), a complication of diabetic retinopathy 2, 3, 4.
- Studies have demonstrated that bevacizumab can improve visual acuity and reduce central macular thickness (CMT) in patients with DME, whereas laser photocoagulation alone may not be as effective 2, 3, 4.
- A network meta-analysis found that bevacizumab, along with other anti-vascular endothelial growth factor (anti-VEGF) drugs, was more effective than laser photocoagulation in improving vision and reducing CMT in patients with DME 3.
- Combination therapy using bevacizumab and navigated laser photocoagulation has also been shown to be effective in treating DME, with significant visual gain and CMT reduction observed at 12 months 5.
Efficacy of Bevacizumab
- Bevacizumab has been found to be effective in reducing CMT and improving visual acuity in patients with DME, with significant improvements observed at 6 and 12 weeks 4.
- The efficacy of bevacizumab in treating DME has been attributed to its ability to inhibit vascular endothelial growth factor (VEGF), a key factor in the pathogenesis of DME 6.
- Bevacizumab has been shown to be a cost-effective treatment option for DME, with a good cost-effective profile compared to other anti-VEGF therapies 6.
Comparison with Other Treatments
- Bevacizumab has been compared to other anti-VEGF drugs, such as ranibizumab and aflibercept, in the treatment of DME, with varying results 3.
- The efficacy of bevacizumab in combination with other treatments, such as triamcinolone, has also been investigated, with some studies suggesting that combination therapy may not provide additional benefits 4.