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Factors tied to outcomes following ranibizumab, PRP treatment for diabetic retinopathy

05 Aug 2018

In the treatment of proliferative diabetic retinopathy (DR), eyes gain vision and rarely develop vision-impairing central-involved diabetic macula oedema (DME) over 2 years with ranibizumab, according to a posthoc analysis. In contrast, factors such as poor glycaemic control and more severe DR increase the likelihood of losing visual acuity and developing DME following panretinal photocoagulation (PRP).

The present analysis involved two cohorts from the Diabetic Retinopathy Clinical Research Network Protocol S, one with available 2-year follow-up data (328 eyes) and another without vision-impairing central-involved DME at baseline (302 eyes). Study eyes had proliferative DR, no prior PRP and best-corrected visual acuity letter score of at least 24 (Snellen equivalent, 20/320 or better). Treatment with either intravitreous ranibizumab (0.5 mg/0.05 ml) or PRP was given.

In the ranibizumab group, no factors emerged as associated with the main outcome measures of change in visual acuity and development of vision-impairing (20/32 or worse) central-involved DME over 2 years.

In the PRP group, on the other hand, worse change in visual acuity was more likely to occur with higher glycated haemoglobin level (HbA1c; –0.6 letters per 1 percent increase; p=0.03), more severe DR (high-risk DR or worse vs moderate DR or better: difference, –2.8 letters; p=0.003) and higher mean arterial pressure (≥100 mm Hg vs <100 mm Hg: difference, –2.0 letters; p=0.009).

Likewise, eyes treated with PRP were at high risk of developing vision-impairing central-involved DME in the presence of higher HbA1c level (hazard ratio [HR] per 1 percent increase, 1.31; p<0.001), more severe DR (high-risk DR or worse vs moderate DR or better: HR, 1.46; p=0.03) and cystoid abnormalities within 500 μm of the macula centre (HR, 2.90; p=0.006).

The present data provide information on factors that potentially influence the outcomes associated with each treatment method for proliferative DR, although they hardly inform decision-making when it comes to selecting one treatment over the other, researchers said.

Given that PRP or anti-VEGF as monotherapies can be effective treatments for DR, it is likely that clinicians will continue to consider both in the management of patients, they added.

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Most Read Articles
04 Oct 2018
A week of preoperative oral antibiotics prior to percutaneous nephrolithotomy does not appear to confer any benefit in patients at low risk for infectious complications, suggests a recent study. Perioperative antibiotics according to the American Urological Association (AUA) Best Practice Statement is deemed sufficient.
09 Oct 2018
The use of statins does not appear to influence the immature platelet count in patients with coronary artery disease (CAD), a new study has shown.
Rachel Soon, 01 Sep 2018

MIMS Pharmacist presents an overview of a standardized extract of Pinus pinaster bark, and its potential role in slowing down the progression of diabetic retinopathy.

Dr. Lau Hui Ling, 01 Aug 2017
Oral contraceptive selection should be individualized for each patient to yield maximum benefit.