Severe Visual Loss Research Articles

FILTRATION SURGERY OF TRABECTULECTOMIES WITH 5 – FLUOROURACIL IN ADVANCED POAG

Introduction : Advanced Glaucoma (AG) is total cupping of optic nerve with or without severe visual field loss. The prevalence of AG in POAG, shows that 15% have a substantial visual field defect. Initial therapy for AG can use medications, surgical therapy is performed when adecuate medical treatment isn’t effective. Filtration surgery such as trabeculectomy and implantation of tube shunts can be performed. This case reports aims to understand the used of trabeculectomy+5FU in Advanced POAG.
 Case Illustration : A 55 years old woman came with blurry and tunnel vision accompanied by headache since 2 years ago. She got treatment yet stopped to control. Vision has progressively reduced since 2 months ago. Visual acuity OD 1/300 OS 1/60, IOP OD 25.1 mmHg and OS 29.8 mmHg with 4 drugs, cloudy lens, cupping, c/d ratio 0.9, nasalization, bayonet sign and peripapillary atrophy. The patient was diagnosed with Advanced POAG with immature senile cataract ODS. Patient was treated with trabeculectomy+5-FU due to uncontrolled IOP despite receiving adecuate therapy. Releasing sutures were used to control IOP after surgery. After surgery, the last IOP OS 12.6 mmHg, and bleb formed E1H1V0.
 Discussion : 
 Conclusion : Patients was treated with trabeculectomy+5-FU, can control IOP stably in advance of POAG without serious complications, cost less than routine drugs and maintain visual function and improve quality of life. Filtration surgery such as trabeculectomy with AF agents is proven to reduce IOP more stably in advance of POAG.

MANAGEMENT EALES’ DISEASE GRADE III B: A RARE CASE

Introduction : Eales' disease is an idiopathic occlusive retinal vasculopathy that mostly affects the peripheral retina bilaterally in young, predominately male patients. A hallmark of eales disease is recurrent vitreous hemorrage can all cause some patients to experience severe vision loss
 Case Illustration : A 39-year-old male with vitreous hemorrhage caused by Eales Disease grade III B with initial visual acuity 1/300. Ultrasound imaging showed the membrane like lesion with 1/2 retinal reflectivity, after moderate movement and vitreous hemorrhage on both eyes. The photo-fundus showed there is decreased fovea reflex and perimacular exudate with visible contours of sclerotic blood vessels, visible cotton wall spot, and macroaneurysm. There is also haze grade 3 on media, visible folds in the inferior part, visible shadows of cotton wall spots. The patient was managed with pars plana vitrectomy with endolaser
 Discussion : In this case, patient was diagnosed as vitreous hemorrhage caused by Eales Disease grade III B on both eyes but it getting worse on left eye further. We chose to perform PPV with endolaser on right eye. The outcome was good on right eye based on better visual acuity and decreased hemorrhage, but in the left eye, which not treated, worsen outcome occurred
 Conclusion : The management of this patient’s case showed good results in both anatomic and functional outcomes for right eye, but unfortunately left eye is on serious problem

Epidemiological and clinical characteristics of open globe injuries in Southwest China.

Open globe injuries (OGIs) are one of the leading causes of monocular vision loss, and the clinical characteristics of OGIs are region specific. The features and patterns of OGIs in Southwest China are poorly known and not well studied. Our study aimed to review the epidemiological and clinical characteristics of patients hospitalized for OGIs in Southwest China. A retrospective study of OGI patients admitted to the West China Hospital from January 1st, 2015, to December 31st, 2019, was performed. Demographic characteristics and injury details were recorded. The Birmingham Eye Trauma Terminology system and the ocular trauma score (OTS) were used. A total of 3,014 patients were included. The male-to-female ratio was 5.2:1, and the mean age was 35.6 ± 19.1 years. 15.2% of patients were from the ethnic groups. The highest-risk occupation was the farmer (30.3%), followed by the worker (28.5%). OGIs occurred more frequently in people with middle (37.0%) and primary school (33.1%) education levels. Types of injuries included 46.8% penetration, 21.2% rupture, 2.9% perforation, and 29.1% intraocular foreign body (IOFB). The injuries types differed between age and occupation groups (p < 0.001). IOFBs had a higher risk of causing endophthalmitis, retinal detachment, and traumatic cataracts (p < 0.001). The most common injuries resulted from sharp objects (72.7%). The causes of the injuries were significantly associated with age, ethnicity, and occupation (p < 0.001). Explosion injuries and attacks by animals were more common among people of Tibetan and Yi ethnicities. Blunt trauma, vehicle crashes, falls and age older than 60 years were risk factors for a lack of light perception and lower OTS scores prognosis. OGIs in Southwest China mainly affected working-aged males, especially workers or farmers. Severe vision loss and IOFBs are more common findings. OGIs in older patients and ethnic minorities requires additional attention.

Optic Neuropathy Associated with POLG Mutations: A Case Series and Literature Review.

The clinical characteristics of patients with polymerase gamma (POLG) mutation-associated optic neuropathy remain incompletely characterized. We describe the clinical characteristics of 3 patients with POLG-associated optic neuropathy. We performed a literature review of optic neuropathy cases associated with POLG mutations and compared them with our cohort. Many published cases of POLG-associated optic neuropathy in our literature review lacked details regarding severity of vision loss, visual field defects, and optical coherence tomography analysis. The clinical presentation of POLG mutations remains widely variable in age (from pediatric cases to adults) and associated systemic findings. All patients in our literature review presented with systemic symptoms, most commonly muscle weakness, ptosis, and ophthalmoplegia, whereas many young patients had severe systemic symptoms. In our case series, all 3 cases had isolated optic neuropathy affecting the papillomacular bundle, with signs such as reduced visual acuity and color vision, central visual field defects, temporal retinal nerve fiber layer loss with temporal optic disc pallor, and retinal ganglion cell complex loss. In addition, 2 of the 3 cases had added mitochondrial stressors in addition to the POLG mutation. Clinicians should be aware that POLG mutations can present as isolated optic neuropathy primarily affecting the papillomacular bundle. With mitochondrial failure being the likely underlying pathogenic mechanism in POLG-associated optic neuropathy, helping affected patients eliminate mitochondrial stressors may be important in reducing the risk for progressive vision loss in this otherwise currently untreatable disorder.

Herpes zoster ophthalmicus

Herpes zoster ophthalmicus (HZO) occurs when latent varicella zoster virus reactivates in the ophthalmic division of the fifth cranial nerve (CNV1). HZO commonly affects older and immunocompromised patients. This disease is considered an ophthalmic emergency due to the wide range of associated ocular symptoms, including severe chronic pain and vision loss. HZO is typically a clinical diagnosis due to its classic presentation of a unilateral vesicular eruption in the dermatomes corresponding to CNV1. Timely treatment is imperative to minimize ocular morbidity in HZO, given that ocular involvement is present in 50% of affected patients.

A Case of Retinal Edema in Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis

Purpose: To report a case of retinal edema and retinal hemorrhage in myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG) positive optic neuritis.Case summary: A 49-year-old male visited the clinic due to decreased vision and eye pain in the left eye after 2 times of right eye and 1 time of left eye optic neuritis. The patient presented with eyelid swelling and retinal hemorrhage as well as optic disc swelling of the left eye. Optical coherence tomography (OCT) showed parafoveal intraretinal fluid. The patient received the intravenous high-dose steroids and the immune globulin therapy. He was then put on maintenance oral steroids and immunosuppressive agents. After the treatment, the best corrected visual acuity of left eye was improved to 0.2. Retinal hemorrhage and retinal edema of the left eye decreased, and optic nerve pale in both eyes was observed. OCT showed overall atrophy of the retinal nerve fiber layer in both eyes.Conclusions: Some patient with MOG-IgG positive optic neuritis will have eyelid swelling or retinal edema that is necessary to be differentiated from eyelid inflammatory disorder or macular disease such as diabetic retinopathy. Thus, clinician should consider MOG-IgG positive optic neuritis in patients with retinal edema when accompanied by eye pain with severe vision loss or repeated disc swelling. When diagnosed with MOG-IgG positive optic neuritis, a combined treatment of relatively long-term steroid treatment and immunosuppressants may be required.

AUTOIMMUNE OPTIC NEUROPATHY (AON) PROFILE AT OPHTHALMOLOGY OUTPATIENT CLINIC OF A TERTIARY HOSPITAL IN SURABAYA, INDONESIA

Highlights Autoimmune optic neuropathy (AON) is one of the diseases that involve the central nervous system (CNS) and can result in disability if not treated quickly and appropriately. The autoimmune optic neuropathy (AON) patient’s profile, including disease etiology and therapy, is essential to minimize the incidence of AON. Abstract Background: Autoimmune optic neuropathy (AON) is a kind of optic neuritis that causes progressive and severe vision loss. The presence of an autoimmune disease usually characterizes the diagnosis of this disease. Several autoimmune processes that can cause AON are Multiple Sclerosis (MS), Neuromyelitis Optica Spectrum Disorder (NMOSD), Myelin Oligodendrocyte Glycoprotein Immunoglobulin (MOG-IgG), and other disorders, specifically systemic autoimmune disease, such as Systemic Lupus Erythematous (SLE), Sjogren’s Syndrome, and Sarcoidosis. Risk factors for AON involve young adults and women. Most of the patients received therapy according to the ONTT protocol and underwent outpatient treatment with oral methylprednisolone or prednisone. Objective: The study aimed to obtain the autoimmune optic neuropathy (AON) profile in patients at the Ophthalmology Outpatient Installation of Dr. Soetomo General Academic Hospital Surabaya, Indonesia, in the 2017-2022 Period. Material and Method: This retrospective descriptive study used medical records; 70 subjects were included. Result: Most subjects suffered from SLE (55.7%) as the cause of AON and received therapy according to the ONTT protocol, namely oral methylprednisolone or prednisone (67.1%) with outpatient therapy. Some patients were given other therapies (25.7%), such as mecobalamin and other B complex vitamins. Conclusion: AON is an uncommon condition. However, if not treated promptly and effectively, it can result in handicaps. This study may serve as a reference for future relevant research and as an attempt to prevent the disease.

Demographic, Socioeconomic, and Clinical Factors Associated with Severe Vision Loss in Patients with Neovascular Glaucoma.

To investigate the association between demographic, socioeconomic, and clinical factors and severe vision loss in patients with neovascular glaucoma (NVG). A retrospective chart review of patients referred to the University of Virginia (UVA), diagnosed with NVG, and treated for NVG between January 2010 and December 2020 was performed. Patients were grouped according to vision outcomes after 1 year of treatment: mild - moderate vision loss (best corrected visual acuity [BCVA] > light perception [LP]) and severe vision loss (BCVA ≤ LP). The associations between patient characteristics and BCVA were also examined. Of the 89 patients (99 eyes), those with progression to severe vision loss presented with higher intraocular pressure (IOP) (p < 0.001) and lower visual acuity (p = 0.003) on average. However, there was no difference in IOP between the vision loss groups after one year of treatment. Univariate analysis showed a moderate association between a history of type 2 diabetes mellitus (T2DM) and severe vision loss (p = 0.033). Increasing age was associated with an increased likelihood of progression to severe vision loss (odds ratio [OR] 1.074, p = 0.008). Females were more likely to exhibit severe vision loss (OR 3.281, p = 0.036). Patients with Medicare (OR 0.098, p = 0.005) or private insurance (OR 0.110, p = 0.006) were less likely to progress to severe vision loss than those without insurance. Progression of vision loss in patients with NVG may be influenced by the stage of disease at diagnosis, age, sex, T2DM, and insurance status.

Brolucizumab and other anti‐VEGF induced intraocular inflammation

Anti‐vascular endothelial growth factor (VEGF) agents, such as bevacizumab, ranibizumab, and aflibercept, are widely used in the treatment of various retinal diseases. Recently, brolucizumab, a novel anti‐VEGF agent, has been introduced in the market for the treatment of neovascular age‐related macular degeneration. However, the use of some anti‐VEGF agents has been associated with an increased risk of intraocular inflammation.In particular, brolucizumab has been reported to be associated with a higher incidence of intraocular inflammation compared to other anti‐VEGF agents. The inflammation can manifest as anterior uveitis, vitritis, or even occlusive retinal vasculitis, and lead to severe and permanent visual loss in some cases. Although the exact mechanism of this phenomenon is not fully understood, it is believed to be related to the immune response triggered by the injection of foreign proteins into the eye.The clinical presentation of intraocular inflammation can range from mild symptoms, such as ocular discomfort and blurry vision, to severe visual loss. Prompt and appropriate management of intraocular inflammation is crucial to preserve vision in patients receiving anti‐VEGF agents. Early detection of inflammation and prompt initiation of anti‐inflammatory treatment can prevent further damage to the eye.In cases of mild to moderate inflammation, close monitoring and topical or systemic anti‐inflammatory medication may be sufficient to control the inflammation and prevent visual deterioration. Cessation of the causative anti‐VEGF treatment may be necessary to prevent further exacerbation of the inflammation. In such cases, the patient may need to be switched to an alternative treatment option for their underlying condition.Overall, clinicians should maintain a high level of vigilance for the development of intraocular inflammation in patients receiving anti‐VEGF therapy. Close monitoring, early detection, and appropriate management of inflammation can help preserve vision and minimize the potential complications associated with these agents.

An Intraoperative Discovery of a Unilateral Pulsating Heartbeat—An Atypical Case of Persistent Foetal Vasculature in the Vitreous with a Silent B-Scan

The foetal vasculature gives nourishment to the developing lens and retina during embryonic development and then regresses after the formation of the retinal vessels. The failure of the foetal ocular vasculature to go through the usually planned involution results in persistent foetal vasculature (PFV), which causes blindness or severe vision loss. In this case, we are reporting a 6-week-old baby with unilateral PFV, which was not evident on ultrasound and was diagnosed incidentally during surgery. The dense, vascularized membrane typically seen behind the lens in these patients may seriously compromise cataract surgery, causing intraoperative bleeding that is sometimes severe enough to force the surgeon to abandon the surgery. The creation of new treatment approaches has been made possible by the recent improvements in micro-invasive surgical methods, which made the early treatment of PFV safer and more successful.

Long‐term efficacy of idebenone in patients with Leber hereditary optic neuropathy in the LEROS study: Analysing change in visual acuity according to causative mutation and disease phase

Aims/Purpose: Leber hereditary optic neuropathy (LHON) is a mitochondrial disease resulting in severe vision loss. The causative mitochondrial DNA (mtDNA) mutation impacts disease progression and prognosis. In LEROS, a Phase IV, open‐label interventional study (Clinicaltrials.gov NCT02774005), visual acuity (VA) outcomes following 24 months of idebenone treatment (IDE) were compared to those of an external Natural History (NH) cohort. Here, we compare VA change from baseline to Month 24 according to primary mtDNA mutation and disease stage.Methods: Eyes of patients with LHON and either a m.G11778A, m.T14484C or m.G3460A, mtDNA mutation were stratified by time since onset: subacute/dynamic (≤1 year) and chronic (&gt;1 but ≤5 years). Data from 181 patients were compared to retrospective data from the NH cohort (N = 372), matched by time since symptom onset at baseline. We compare the difference in least squares‐mean VA change, or delta VA, from baseline to Month 24 in IDE versus NH eyes (a negative value favours IDE).Results: In treated subacute/dynamic m.G11778A eyes (n = 60 IDE), delta VA was −0.32 logMAR (p = 0.002) versus the NH cohort (n = 47). In chronic m.G11778A eyes, delta VA was −0.11 logMAR (n = 82 IDE vs n = 51 NH; p = 0.043). In subacute/dynamic m.T14484C eyes, delta VA was +0.20 logMAR (n = 35 IDE vs n = 10 NH; p = 0.285). In chronic m.T14484C eyes, delta VA was −0.52 logMAR (n = 11 IDE vs n = 18 NH; p &lt; 0.001). In subacute/dynamic m.G3460A eyes, delta VA was +0.53 logMAR (n = 26 IDE vs n = 18 NH; p = 0.001). In chronic m.G3460A eyes, delta VA was −0.13 logMAR (n = 23 IDE vs n = 24 NH; p = 0.162).Conclusions: Idebenone improved VA in a large proportion of eyes; this benefit manifested to varying degrees depending on disease stage and mtDNA mutation. m.G11778A eyes saw a consistent benefit regardless of disease stage. m.T14484C and m.G3460A results should be interpreted with caution in some cases due to the relatively low number of eyes; further study is warranted.

Ultrasound Biomicroscopy and echogenic external marker assisted Intraocular Foreign Body Removal.

We report a novel method of intra-operative localization of a retained anterior intraocular foreign body (IOFB), using a combination of ultrasound biomicrosopy (UBM) and an insulated needle. A retrospective case report of 56-year-old male who presented with a right eye IOFB. On presentation, vision was decreased in the right eye to count fingers with a small subconjunctival hemorrhage but no other signs of a penetrating laceration. Orbital CT revealed an IOFB and the initial vitrectomy failed to retrieve the IOFB. Then during the subsequent vitrectomy, using an ultrasound compatible needle and a UBM, we were able to precisely locate and remove the small anterior IOFB. Retained IOFBs can lead to severe irreversible vision loss if not promptly removed. Ancillary imaging modalities and localization techniques can help locate occult IOFBs in difficult cases.

Endothelial Dysfunction is Related to Central Retinal Artery Occlusion

Objective: Central retinal artery occlusion (CRAO) is severe and painless vision loss due to retinal infarction. Most CRAO patients have atherosclerotic risk factors. Flow-mediated dilatation (FMD) and pulse wave velocity (PWV) may indicate the presence or progression of atherosclerosis. This study aims to evaluate the arterial stiffness parameters and the presence of endothelial dysfunction in patients with CRAO. Materials and Methods: 33 consecutive CRAO patients (63 ± 7 years, 21 men (63.6%)) were recruited in the study. 35 age /sex-matched participants were included as a control group, FMD and PWV were measured from the brachial artery, as indicators of endothelial dysfunction and atherosclerosis in the arterial wall, respectively. Additionally, the transthoracic echocardiographic parameters of the patients were investigated. Results: CRAO patients had significantly higher frequencies of hypertension, hyperlipidemia, and smoking status. Furthermore, the frequency of diabetes was also higher in the CRAO group, but the difference was not statistically significant. CRAO patients had significantly higher PWV and lower FMD compared to the controls. There were no significant differences between groups regarding left ventricle systolic and diastolic functions. Conclusion: Our study showed that CRAO patients may have endothelial dysfunction and increased arterial stiffness. Systemic endothelial dysfunction and atherosclerosis may be linked to the development of CRAO.

The two extremes of retinal fold management

Aims/Purpose: Retinal folds represent a debilitating complication following retinal detachment surgery. While some patients may experience partial retinal flattening with minimal or moderate improvement of visual function, many will go on to suffer severe permanent vision loss. The indication and timing of possible reintervention is still debated, particularly for how long after initial retinal fold formation there can still be a reasonable expectation of anatomical and functional improvement.Methods: We present the cases of two patients suffering debilitating postoperative macular folds at opposite ends of the intervention window, who were referred to the Jules Gonin Hospital at different postoperative timepoints following retinal detachment surgery. Patient Nr 1 was reoperated within 20 days of the initial surgery, patient Nr 2 10 months later. Retinal folds were confirmed by preoperative OCT and pre‐ and post‐op cyclotorsion was measured on fundus photography.Results: Patient Nr 1 recovered vision from CF to 0.2 logMar within 3 months, improving to 0.0 logMar after one year. Patient No 2 recovered from HM to 0.6 after 3 months and further to 0.5 logMar after one year. Most importantly, while patient Nr 1 had no more cyclotorsion, undisturbed binocular vision already on day one postoperatively, even to the absence of metamorphopsia during follow‐up, patient Nr 2 recovered slowly, also regaining binocularity without cyclotorsion, but with lasting metamorphopsia. During the video presentation, the different retinal elasticity at these differing timepoints can be demonstrated intraoperatively as well as different strategies to induce retinal separation so that the central retina can be reattached in a new, more physiological position.Conclusions: Our cases illustrate that early intervention can lead to a virtually symptom‐free result while even delayed intervention may still be able to achieve some improvement in visual function and the avoidance of monocularity.

Archetypal analysis for dominant optic atrophy visual field loss

Aims/Purpose: Identification of the characteristic visual field loss patterns of dominant optic atrophy (DOA) employing the Archetypal Analysis (AA) machine learning algorithm and further relation with patient‐specific parameters.Methods: For 64 patients affected by molecularly confirmed DOA with OPA1 heterozygous mutation, binocular visual field (VF) tests performed by SITA standard 30–2 or 24–2 Humphrey VF analyser (Carl Zeiss Meditec, Dublin, CA, USA) were collected. For patients that had multiple VF tests, several VFs were collected to enlarge the dataset. Resorting to Python 3.8 (Anaconda) an AA model was developed to determine and quantify the DOA underlying patterns of visual loss. After a careful analysis involving different linear and non‐linear machine Learning models and algorithms, the different archetypes (AT) were related to parameters such as age and visual acuity.Results: Considering 229 VF test, employing the AA, twelve archetypes were detected for the characterization and quantification of visual loss in DOA. Central, ceco‐central, and para‐central ATs revealed to be the most significant ones, matching the common characteristic scotomas for DOA patients, followed by quadrantanopia, altitudinal, and nasal step ATs.Younger patients were related to less severe visual loss representative ATs, while patients with lower visual acuity were related to more severe visual loss representative ATs.Conclusions: Archetypal analysis shows to be a potential powerful tool to support clinicians in the identification of DOA patients by identifying and quantifying visual loss patterns characteristic of this disease. Relation with other patient‐specific parameters might strengthen the differential DOA diagnosis.

OCTA ischemic changes in three patients with unexplained severe visual loss related to silicone oil tamponade

OCTA ischemic changes in three patients with unexplained severe visual loss related to silicone oil tamponade

Ocular delivery of Pigment Epithelium-Derived Factor (PEDF) as a neuroprotectant for Geographic Atrophy.

Geographic atrophy (GA) is an advanced form of age-related macular degeneration (AMD), that starts with atrophic lesions in the outer retina that expand to cover the macula and fovea, leading to severe vision loss over time. Pigment Epithelium-Derived Factor (PEDF) has a diverse-range of properties, including its ability to promote cell survival, reduce inflammation, inhibit angiogenesis, combat oxidative stress, regulate autophagy, and stimulate anti-apoptotic pathways, making it a promising therapeutic candidate for GA. However, the relatively short half-life of PEDF protein has precluded its potential as a clinical therapy for GA since it would require frequent injections. Therefore, we describe administration of a PEDF gene, comparing and contrasting delivery routes, viral and non-viral vectors, and consider the critical challenges for PEDF as a neuroprotectant for GA.

Global, regional and national burden of retinopathy of prematurity among childhood and adolescent: a spatiotemporal analysis based on the Global Burden of Disease Study 2019

BackgroundThis study aimed to provide a comprehensive assessment of burden estimates and the secular trend of vision loss due to retinopathy of prematurity (ROP) among people younger than 20 years,...

Atrial fibrillation as a novel risk factor for retinal stroke: A protocol for a population-based retrospective cohort study.

Central retinal artery occlusion (CRAO; retinal stroke or eye stroke) is an under-recognized, disabling form of acute ischemic stroke which causes severe visual loss in one eye. The classical risk factor for CRAO is ipsilateral carotid stenosis; however, nearly half of patients with CRAO do not have high-grade carotid stenosis, suggesting that other cardiovascular risk factors may exist for CRAO. Specifically, prior studies have suggested that cardioembolism, driven by underlying atrial fibrillation, may predispose patients to CRAO. We describe the design of an observational, population-based study in this protocol. We evaluate two specific objectives: 1) To determine if atrial fibrillation is an independent risk factor for CRAO after adjusting for medical and cardiovascular risk; 2) To determine if use of oral anticoagulation can modify the risk of CRAO for patients with atrial fibrillation. This protocol lays out our strategy for cohort definition, case and control definition, comorbidity ascertainment, and statistical methods.

Regression of Neovascularization after Panretinal Photocoagulation Combined with Anti-VEGF Injection for Proliferative Diabetic Retinopathy-A Review.

Proliferative diabetic retinopathy (PDR) poses a significant therapeutic problem that often results in severe visual loss. Panretinal photocoagulation (PRP) has long been a mainstay treatment for this condition. Conversely, intravitreal anti-VEGF therapy has served as an alternative treatment for PDR. This review aimed to evaluate the effects of PRP combined with anti-VEGF therapy on the regression of neovascularization (NV), including functional outcomes and incidence of complications. The MEDLINE database was searched for articles evaluating regression of NV using a combination of the following terms: "proliferative diabetic retinopathy", "anti-VEGF", "panretinal photocoagulation", and "combined treatment". The search yielded a total of 22 articles. The analysis of their results indicated PRP combined with ant-VEGF therapy as superior over PRP alone in the management of PDR. Combination treatment yields better and faster regression of NV and a lower incidence of serious complications, such as vitreous hemorrhage and the need for pars plana vitrectomy. Nevertheless, complete regression of NV is not achieved in a significant proportion of patients. Further research is needed to establish the most effective schedule for intravitreal injections as an adjunct to PRP. The current literature shows that in some cases, cessation of anti-VEGF injection in combination treatment for PDR can lead to relapse of NV.