Anti-VEGF alone offers superior reduction of diabetic macular edema compared with laser photocoagulation

Ophthalmology. 2009;116(11):2175-2181.

An anti-VEGF regimen offered in four doses over 6 months provided superior visual and anatomic outcomes over focal/grid laser photocoagulation or combined anti-VEGF and laser therapy in a study of 126 patients with diabetic macular edema.

At month 6, gain in best corrected visual acuity was superior in 42 patients who received intravitreal injections of Lucentis (ranibizumab, Genentech) vs. 42 patients who received laser photocoagulation at baseline and again at 3 months if needed (+7.24 letters vs. –0.43 letters). A total of 42 patients who received laser photocoagulation at baseline and injection of ranibizumab at month 3 had a mean gain in BCVA of +3.8 letters, but the difference compared with the other treatment groups was not statistically significant.

While 22% of the patients on ranibizumab monotherapy gained three lines or more of vision, the rates were 0% for laser and 8% for combination therapy. Likewise, excess foveal thickness was more prominently reduced in ranibizumab monotherapy patients: 50% vs. 33% for laser and 45% for combination therapy.

According to the study authors, the data support earlier findings from a small case series demonstrating the effectiveness of anti-VEGF therapy in reducing macular edema. However, patients in that study were given three monthly doses of ranibizumab followed by two bimonthly doses, which led to an 85% reduction of edema at 7 months; in the current study, only 50% of edema was resolved in patients in the monotherapy group using a less aggressive approach to therapy.