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Anti-VEGF use on the rise for treatment of diabetic retinopathy
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WAIKOLOA, Hawaii — Current data indicate that anti-VEGF injections are an effective form of treatment for diabetic retinopathy, according to a speaker here.
“Our current algorithm is based off some very old but very good data, the Diabetic Retinopathy Study, that was published in Ophthalmology in 1978, so we really have not deviated much from that since that time, and it shows that panretinal photocoagulation reduces the risk of severe vision loss by 50%,” Michael S. Ip, MD, said at Retina 2016. “But it really is an inherently destructive treatment.”
Michael S. Ip
Acute complications of PRP include discomfort, vasovagal response, misplaced spots, foveal burns, corneal epithelial trauma, loss of visual field, loss of night vision, loss of color vision, loss of accommodation and potential exacerbation of diabetic macular edema, he said.
In the Protocol S study conducted by the DRCR.net, researchers wanted to determine if visual acuity outcomes at 2 years in eyes with proliferative diabetic retinopathy that receive Lucentis (ranibizumab, Genentech) therapy with deferred PRP were noninferior to eyes that receive prompt PRP therapy, he said.
“All patients received four injections at baseline,” Ip said. “Starting at the 6-month visit, the injections could be deferred or continued based on whether the patient had stable, worsened or improved situations with their neovascularization.”
Mean change in visual acuity at 2 years was +2.8 letters in the ranibizumab group compared with +0.2 letters in the PRP group, he said.
The presence of DME may influence the relative benefit of ranibizumab over PRP. PRP may be unnecessary when DME is present and treatment with an anti-VEGF agent is planned, and when DME is not present, ranibizumab is more effective than PRP in preserving peripheral function, Ip said.
“PRP has served us well over the years, but I think current data indicate anti-VEGF therapy may be an effective treatment for diabetic retinopathy severity and may be a replacement for PRP,” Ip said. “We look forward to further studies to help guide us on the use of anti-VEGF to treat PDR.” – by Nhu Te
Reference:
Ip MS. Treatment of diabetic retinopathy: Is it time for a new approach? Presented at: Retina 2016; Jan. 18-22; Waikoloa, Hawaii.
Disclosure: Ip reports he is a consultant for Boehringer Ingelheim and ThromboGenics.