Ranibizumab trumps panretinal photocoagulation for proliferative diabetic retinopathy
Higher haemoglobin A1c level and more severe diabetic retinopathy for eyes managed with panretinal photocoagulation (PRP) are associated with less vision improvement and an increased risk of developing vision impairing central-involved diabetic macular oedema (DME), a study has shown.
On the other hand, treating proliferative diabetic retinopathy (PDR) with ranibizumab results in improved vision, with no baseline characteristics identified as associated with visual acuity or central-involved DME outcomes.
There were no factors associated with change in visual acuity or development of vision-impairing central-involved DME among eyes managed with ranibizumab after multivariable model selection with adjustment for baseline visual acuity and central subfield thickness.
For eyes managed with PRP, higher haemoglobin A1c level (–0.6 letters per 1-percent increase; 95 percent CI, –1.2 to –0.1 letters; p=0.03), more severe diabetic retinopathy (difference between high-risk PDR or worse vs moderate PDR or better, –2.8 letters; –5.5 to –0.2 letters; p=0.003) and higher mean arterial pressure (difference between ≥100 vs <100 mm Hg, –2.0 letters; –4.6 to 0.5 letters; p=0.009) were more likely to result in worse change in visual acuity.
Development of vision-impairing central-involved DME was associated with higher haemoglobin A1c level (hazard ratio [HR] per 1-percent increase, 1.31; 1.13–1.52; p<0.001), more severe diabetic retinopathy (HR for high-risk PDR or worse vs moderate PDR or better, 1.46; 0.73–2.92; p=0.03) and the presence of cystoid abnormalities within 500 μm of the macula centre (HR, 2.90; 1.35–6.24; p=0.006).
This posthoc analysis of randomized, multicentre clinical trial data included eyes completing the 2-year visit (n=328) or without vision-impairing central-involved DME at baseline (n=302) in Diabetic Retinopathy Clinical Research Network Protocol S. Eyes were treated either with intravitreous ranibizumab (0.5 mg/0.05 ml) or PRP.