The authors are commenting on the article entitled “Randomized trial of wide-field guided PRP for diabetic macular oedema treated with ranibizumab” published by Talks et al. in Eye 2019; 33(6):930-937. After thorough analysis of the issues related to the addition of targeted panretinal photocoagulation to areas of nonperfusion in patients with macular diabetic oedema the authors concluded that the specific anti-vascular endothelial growth factor drugs (e.g., bevacizumab/ ranibizumab/aflibercept) represent the front-line therapy for the treatment of diabetic macular oedema but only the vascular endothelial growth factor inhibition may not be sufficient to decrease inflammatory response. Therefore, addition of a non-specific anti-vascular endothelial growth factor substance, (e.g., corticosteroid implant) is mandatory. As for the role of targeted panretinal photocoagulation to areas of nonperfusion, the retinal lesions that develop after panretinal photocoagulation increase vascular endothelial growth factor expression and induce breakdown of blood-retina barrier dysfunction and hard exudates formation. The pre-existing diabetic macular oedema prior to panretinal photocoagulation results in overburdened retinal pigment epithelium, so that panretinal photocoagulation could aggravate diabetic macular oedema.
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