Skip to main content

  • Baseline Influencers of Vision and Edema in Proliferative DR: Ranibizumab Versus PRP

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
    Add to My Bookmarks

    Journal Highlights

    Ophthalmology, November 2018

    Download PDF

    In a post hoc analysis of data from randomized multicenter trials, Bressler et al. aimed to identify baseline factors associated with change in visual acuity (VA) or development of vision-impair­ing central-involved diabetic macular edema (DME) occurring after treat­ment of proliferative diabetic retinopathy (PDR) with ranibizumab or panretinal photocoagulation (PRP).

    The study included 328 eyes that received 2 years of follow-up and 302 eyes that did not have vision-impairing central-involved DME at baseline in Protocol S of the Diabetic Retinopathy Clinical Research Network (DRCR.net). The latter eyes were not required to complete the 2-year visit because the analysis incorporated all available and censored data for participants without vision-impairing central-involved DME.

    Treatments were intravitreous ranibizumab (0.5 mg/0.05 mL) or PRP. Primary outcome measures were change in VA (area under the curve) and development of vision-impairing (20/32 or worse) central-involved DME during the 2-year period.

    After multivariable analysis with adjustment for baseline VA and central subfield thickness, no factors were identified as being relevant to either primary outcome. In the PRP group, worsening VA was more common with higher levels of hemoglobin A1c, greater severity of diabetic retinopathy (DR), and higher mean arterial pressure. Vision-impairing central-involved DME was more likely to occur in the presence of high hemoglobin A1c, more severe DR, and cystoid defects within 500 μm of the macula center.

    Overall, VA improved and vision-impairing central DME was rare with ranibizumab in Protocol S. The analysis suggests that these favorable outcomes occur regardless of baseline factors. However, when PRP is the main treatment for PDR, patients with poor glycemic control or severe DR may be more susceptible to vision-impairing central-involved DME and VA loss than are those with better glycemic control or milder DR, even if the DME is treat­ed with ranibizumab.

    The original article can be found here.