Comparative Efficacy of Intravitreal Aflibercept versus Panretinal Photocoagulation for Proliferative Diabetic Retinopathy: A Randomized Controlled Trial

Abstract

Proliferative diabetic retinopathy (PDR) remains a leading cause of preventable blindness among working-age adults worldwide. Pan retinal photocoagulation (PRP) has long been the standard of care, but intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents have emerged as an alternative that may preserve visual function while inducing regression of neovascularization. To compare the efficacy and safety of intravitreal aflibercept versus PRP in eyes with high-risk PDR over 52 weeks. In this trial conducted in Thi-Qar, Iraq, adults with treatment-naïve high-risk PDR were randomized 1:1 to intravitreal aflibercept (2.0 mg every 4 weeks for the first 3 doses, then per protocol) or standard PRP delivered over 1–3 sessions. The primary outcome was mean change in best-corrected visual acuity (BCVA) at week 52; secondary outcomes included central macular thickness (CMT), diabetic retinopathy severity score (DRSS) regression, and adverse events. The aflibercept group demonstrated a greater mean BCVA gain and a higher proportion of eyes achieving ≥ 2-step DRSS regression compared with the PRP group, with a lower rate of vitreous hemorrhage. Both interventions were generally well tolerated.Intravitreal aflibercept demonstrated visual and anatomic advantages for PDR, while PRP remains a durable, low-cost option, particularly where follow-up adherence cannot be guaranteed.