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Perioperative anti-VEGF injections improve vision and reduce bleeding in proliferative diabetic retinopathyAnti-VEGF injections before eye surgery improve vision and reduce bleeding in diabetic retinopathy

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Key Takeaway
Consider timing perioperative anti-VEGF injections based on individualized treatment objectives for proliferative diabetic retinopathy.

This network meta-analysis examined the impact of perioperative anti-VEGF injections on patients with proliferative diabetic retinopathy. The researchers assessed various surgical timings to determine their effect on visual outcomes and surgical complications. The analysis included a substantial number of eyes across multiple studies to compare different intervention strategies.

The findings suggest that administering anti-VEGF agents prior to surgery leads to significant improvements in postoperative best-corrected visual acuity. Additionally, the data indicates a reduction in recurrent vitreous hemorrhage and intraoperative bleeding when injections are given before the procedure. No significant effects were observed regarding the use of silicone oil or recurrent retinal detachment.

The authors note important limitations, including variability in evidence quality and heterogeneity among the included studies. These factors suggest that the certainty of the conclusions is not high. Consequently, clinicians may select the optimal timing based on individualized treatment objectives rather than relying on a single standardized protocol.

A network meta-analysis examined the effects of giving anti-VEGF injections around the time of eye surgery for proliferative diabetic retinopathy. The analysis included data from 2,646 eyes across various studies. Researchers looked at how the timing of these injections affected visual acuity and surgical outcomes.

The study found that receiving anti-VEGF injections before surgery significantly improved postoperative best-corrected visual acuity. This improvement was seen regardless of whether the injection was given more than seven days before, three to seven days before, or on the day of surgery. Additionally, the use of these injections reduced the risk of recurrent vitreous hemorrhage and intraoperative bleeding.

Surgical time was also shortened when injections were administered more than seven days before the procedure. There were no significant effects on the need for silicone oil or the risk of recurrent retinal detachment. The overall tolerability of the treatment was considered favorable, though no specific adverse events were reported in the data provided.

Clinicians may select the optimal timing for these injections based on individualized treatment objectives. However, conclusions should be approached with caution due to variability in evidence quality and heterogeneity among the included studies. This analysis suggests potential benefits for surgical planning but does not establish a single standard of care.

What this means for you:
Perioperative anti-VEGF injections may improve vision and reduce bleeding in diabetic retinopathy surgery, though evidence quality varies.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
PURPOSE: Proliferative diabetic retinopathy causes severe vision loss. Although anti-vascular endothelial growth factor (VEGF) injections aid surgery outcomes, optimal timing is unclear. We evaluated the efficacy and safety of anti-VEGF injections at various perioperative time points. METHOD: This network meta-analysis comprehensively searched PubMed, Cochrane Library, Web of Science, Embase, ClinicalTrials.gov, and WHO ICTRP from inception to November 2024 for randomized controlled trials examining perioperative anti-VEGF injection. Two authors independently screened the studies, collected the data, and assessed the risk of bias. The protocol was registered with PROSPERO (CRD42024614758). RESULTS: Thirty studies involving 2 646 eyes were analyzed. Perioperative anti-VEGF treatment significantly improved postoperative best-corrected visual acuity (preoperatively >7 days: standardized mean difference [SMD] = 0.57, 95% CI: 0.01-1.13; preoperatively 3-7 days: SMD = 0.50, 95% CI: 0.29-0.70; intraoperative: SMD = 0.34, 95% CI: 0.10-0.66). It also reduced recurrent vitreous hemorrhage (intraoperative: odds ratio [OR] = 0.28, 95% CI: 0.09-0.87), and intraoperative bleeding (preoperatively >7 days: OR = 0.11, 95% CI: 0.03-0.39; preoperatively 3-7 days: OR = 0.22, 95% CI: 0.04-1.13). Additionally, it shortened surgical time (preoperatively >7 days vs preoperatively 1-3 days: WMD = -17.90, 95% CI: -29.99 to -5.81). No significant effects on silicone oil use or recurrent retinal detachment were observed. The safety profile of anti-VEGF has been found to be favourable. CONCLUSIONS: The combination of perioperative anti-VEGF injections provides several advantages. Clinicians may select the optimal timing based on individualized treatment objectives. However, because of the variability in evidence quality and the heterogeneity among the included studies, these conclusions should be approached with caution.
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