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Long-term results support PRP or ranibizumab for diabetic retinopathy
The treatments resulted in good visual acuity, but vitreous hemorrhage developed in almost half of both groups.
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The 5-year results of the DRCR.net Protocol S study support the use of ranibizumab or panretinal photocoagulation as viable treatments for proliferative diabetic retinopathy.
The Diabetic Retinopathy Clinical Research Network evaluated 394 study eyes with proliferative diabetic retinopathy in a multicenter randomized clinical trial. Researchers evaluated the mean change in visual acuity in patients treated with either intravitreous Lucentis (ranibizumab, Genentech) or panretinal photocoagulation (PRP).
Left untreated, proliferative diabetic retinopathy can lead to blindness. The results of the trial demonstrate that either anti-VEGF injections or PRP treatments result in “very good visual acuity” in most treated eyes over 5 years and that severe vision loss or other serious ocular complications are rare, Adam R. Glassman, MS, the director/principal investigator of the DRCR.net Coordinator Center and a co-author of the study, told Ocular Surgery News.
“However, vitreous hemorrhage developed in almost half of both groups. There are advantages and disadvantages to both approaches. Anti-VEGF results in lower rates of vision-impairing diabetic macular edema or development of retinal detachment and less visual field loss compared with PRP. However, anti-VEGF may be more expensive and may require more visits and more injections over the course of 5 years,” Glassman said.
Visual acuity improvements
At baseline, 394 eyes of 305 study participants were randomly assigned to receive either ranibizumab or PRP. In total, 191 eyes were treated with ranibizumab and 203 eyes were treated with PRP. At 5 years, 66% of participants, excluding deaths, completed the full study.
Visual acuity in both treatment groups improved from baseline to the 5-year final follow-up visit. Ranibizumab patients improved by a mean 3.1 letters, and PRP patients improved by a mean 3 letters. The mean visual acuity at 5 years in both groups was 20/25 compared with 20/32 at baseline.
At 5 years, 12 eyes in the ranibizumab group had identifiable retinal detachments compared with 30 eyes in the PRP group. Four eyes in the ranibizumab group and 11 eyes in the PRP group received vitrectomy for the retinal detachments, but no other procedures for the detachments were performed.
Other results
At the 5-year follow-up visit, the mean central subfield thickness in 40 eyes with baseline DME decreased from baseline by 139 µm and 59 µm in the ranibizumab and PRP groups, respectively. Eyes without DME at baseline (192 eyes) had a 22% cumulative probability in the ranibizumab group of developing vision-impairing DME at 5 years compared with 38% cumulative probability of eyes in the PRP group.
Nearly half of patients in both groups developed any vitreous hemorrhage over 5 years, with 22% of eyes in the ranibizumab group that developed vitreous hemorrhage undergoing vitrectomy compared with 41% of eyes in the PRP group.
“The likelihood of the patient returning for follow-up visits and being compliant with the treatment regimen is an important consideration when deciding whether to treat [proliferative diabetic retinopathy] with an anti-VEGF or PRP,” Glassman said. – by Robert Linnehan
- References:
- Gross JG, et al. JAMA Ophthalmol. 2018;doi:10.1001/jamaophthalmol.2018.3255.
- Gross JG. Randomized trial of panretinal photo-coagulation versus ranibizumab for proliferative diabetic retinopathy: 5-year outcomes. Presented at: American Society of Retina Specialists annual meeting; July 20-25, 2018; Vancouver, British Columbia.
- For more information:
- Adam R. Glassman, MS, can be reached at Jaeb Center for Health Research, 1530 Amberly Drive, Suite 350, Tampa, FL 33647; email: aglassman@jaeb.org.
Disclosure: Glassman reports receiving grants from the National Institutes of Health and Genentech during the conduct of the study; nonfinancial support from Genentech and Allergan during the conduct of the study; and grants from Regeneron outside the submitted work.