Outcomes of anti‑VEGF therapy compared with conventional interventions in diabetic retinopathy management

The present study aimed to observe the progression of diabetic retinopathy (DR) and compare the clinical outcomes of anti‑vascular endothelial growth factor (anti‑VEGF) therapy, laser photocoagulation and vitrectomy in a real‑world setting, to inform treatment strategies. The present prospective, observational study enrolled 371 patients (466 eyes) with DR who were followed for over 3 years at Xi'an Bright Eye Hospital (Xi'an, China). Patients received treatment with anti‑VEGF, laser, combined therapy or vitrectomy based on their clinical condition. Best‑corrected visual acuity (BCVA), central subfield thickness (CST) and incidence of complications were evaluated. The anti‑VEGF group demonstrated a significantly greater improvement in BCVA and a reduction in CST compared with the laser group. Eyes with early‑stage DR required fewer anti‑VEGF injections to achieve stability than those with advanced disease. In eyes with low vision, the anti‑VEGF group had a lower incidence of tractional retinal detachment but a higher rate of persistent macular edema compared with those in the laser group. For stages 4‑5 DR, the rate of vision improvement was similar between anti‑VEGF therapy and vitrectomy. In conclusion, anti‑VEGF therapy is generally superior to laser in improving visual and anatomical outcomes. However, treatment strategies should be individualized based on disease stage and specific complications, with anti‑VEGF favoring traction prevention and laser potentially offering better control for recurrent edema in some cases.