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Aaditi Anil Kumar
This previously healthy 7YO boy presented with asymptomatic retinal findings. Vision was 20/25 in his normal OD and 20/25 OS.
Color photography shows a diffuse network of dilated, tortuous vessels involving the optic disc and posterior pole, extending into the superonasal and temporal midperiphery. Vascular sheathing is noted in the temporal periphery as well. OCT scanning through the disc and nasal macula shows these hyperreflective vessels to variably extend through the full-thickness retina with posterior shadowing. The internal limiting membrane is suspended between two of these lesions.
Learning Points:
A retinal arteriovenous malformation (AVM) is a congenital connection between an artery and vein without an intervening capillary network. These lesions appear along a spectrum ranging from small, isolated lesions to the large ‘bag of worms’ appearance. These more extensive AVMs are usually part of Wyburn-Mason Syndrome, which includes ocular and midbrain vascular lesions. Although retinal AVMs are usually stable lesions, bleeding or secondary venous occlusions may occur.
MRI scanning revealed an intracranial AVM, and the patient was referred for neurosurgical evaluation.
Retina. 2026 Aug 1;46(8):1388-1395. doi: 10.1097/IAE.0000000000004861.
Management of PDR within the first year of Dx from 2005 to 2024: Shifted from PRP monotherapy toward anti-VEGF (including combination and monotherapy) — Retrospective, TriNetX database.
Purpose: To examine trends in initial treatment modality for patients diagnosed with proliferative diabetic retinopathy (PDR).
Methods: A cross-sectional time series was performed between 2005 and 2024 using the TriNetX US Collaborative Network. Patients with new-onset PDR were identified, and initial treatment modality within one year after diagnosis was recorded. The proportion of patients managed with panretinal photocoagulation (PRP) monotherapy, antivascular endothelial growth factor (anti-VEGF) monotherapy, or combination therapy (PRP + anti-VEGF) were compared using Cochran-Armitage tests for trend. Rates of change in treatment proportionality were compared between 2005 to 2014 and 2015 to 2024, the time period before and after the publication of the Diabetic Retinopathy Clinical Research Network Protocol S.
Results: A total of 14,768 patients with newly diagnosed PDR met inclusion criteria. In 2005, PRP monotherapy accounted for 100% of initial treatment. In 2024, combination therapy was the most commonly used treatment modality, accounting for 42.4% of cases (overall trend, P < 0.0001), followed by anti-VEGF monotherapy at 36.1% (overall trend, P < 0.0001), and PRP monotherapy at 21.5% (overall trend, P < 0.0001). After 2015, the annual rate of change differed significantly compared with the pre-2015 period for both monotherapies. The proportion of patients treated with PRP monotherapy showed a steeper relative annual decline (5.22% vs. 3.56% per year, P = 0.0338), while anti-VEGF monotherapy demonstrated a greater relative annual increase (2.03% vs. 1.58% per year, P = 0.0283).
Conclusion: Management of PDR has shifted over the past two decades from PRP monotherapy toward anti-VEGF therapy, including both combination therapy and monotherapy.
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