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Treatment type, baseline characteristics associated with VA, DME
Post-hoc analysis of Diabetic Retinopathy Clinical Research Network Protocol S study data found worse visual outcomes and development of diabetic macular edema were associated with certain risk factors when panretinal photocoagulation rather than ranibizumab was used as treatment in patients with proliferative diabetic retinopathy.
The same risk factors were not significantly associated when ranibizumab intravitreal injection was used for treatment.
Researchers established two cohorts culled from the Protocol S study group: 328 eyes of patients who completed the 2-year visit and 302 eyes without vision-impairing central-involved diabetic macular edema (DME).
Mean visual acuity improvement at 2 years was 4.7 letters in eyes treated with ranibizumab vs. a decrease of 0.3 letters in eyes treated with PRP. In the PRP group, eyes with more severe retinopathy or higher hemoglobin A1c level at baseline tended to improve less, and there was a greater incidence of severe center-involved DME over 2 years. Higher mean arterial pressure and cystoid abnormalities within 500 µm of the center of the macula were additional risk factors for developing DME. A secondary analysis of eyes without DME at baseline confirmed hemoglobin level and more severe retinopathy as risk factors.
No factors were associated with worse visual outcomes in the ranibizumab group, although subgroup analysis of patients without DME at baseline showed a possible association with prior DME treatment.
“When PRP is the primary treatment method for PDR, eyes of persons with poor glycemic control or more severe diabetic retinopathy may be more apt to lose visual acuity and develop vision-impairing, central-involved DME than eyes of persons with lower HbA1c level or less severe diabetic retinopathy,” the authors wrote. – by Michela Cimberle and Robert Linnehan
Disclosures: Bressler reports she receives financial support from Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharm, Notal Vision, Novartis, Genentech, Spark Therapeutics and Merck & Co. Please see the full study for a list of all other authors’ relevant financial disclosures.