Clinical efficacy of intravitreal aflibercept versus panretinal photocoagulation for best corrected visual acuity in patients with proliferative diabetic retinopathy at 52 weeks (CLARITY): a multicentre, single-blinded, randomised, controlled, phase 2b, non-inferiority trial

Sivaprasad, Sobha; Prevost, A. Toby; Vasconcelos, Joana; Riddell, Amy; Murphy, Caroline; Kelly, Joanna; Bainbridge, James; Tudor-Edwards, Rhiannon; Hopkins, David; Hykin, Philip; Bhatnagar, Ajay S.; Burton, B J L; Chakravarthy, Usha; Eleftheriadis, Haralabos; Empeslidis, Theodoros; Gale, Richard; George, Sheena; Habib, Maged; Kelly, Scott P.; Lotery, Andrew; McKibbin, Martin; Membrey, Luke; Menon, Geeta; Mushtaq, Bushra; Nicholson, Luke; Ramu, Jayashree; Osoba, Olayinka; Patel, Jawaharlal M.; Prakash, Priya; Purbrick, Robert; Ross, Adam H; Stylianides, Amira; Talks, James; Harding, Simon; Pető, Tünde; Yeo, Seow Tien; Laidlaw, Alistair; Amoaku, Winfried; Hood, Gillian; Hitman, G. A.; Preece, Daniel; Burns, Philip A.; Walker, Sarah; Mensah, Evelyn; Karia, Niral

doi:10.1016/s0140-6736(17)31193-5

Cited by 323 publications

(312 citation statements)

References 20 publications

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“…These observations reinforce the importance of expanding the total treated area by increasing the number of laser spots with this PRP strategy for maintaining its efficacy. Protocol S of the DRCR.net [3] and CLARITY [4] studies were not designed to compare single-spot and multispot PRP strategies regarding their efficacy, describing only the percentages of patients that received one or the other treatment. So, the relevance of such a topic is still high and larger prospective studies are needed.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies such as the Protocol S of the Diabetic Retinopathy Clinical Research Network (DRCR.net) [3] and the CLARITY study [4] have found clear benefits supporting the use of anti-angiogenic intravitreal drugs in patients with proliferative DR (PDR). Both studies reported superior visual acuity (VA) gains, decreased visual field sensitivity loss, less progression to vitrectomy, and reduced macular thickness in patients treated with drugs compared to those treated with PRP.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of 577-nm Multispot and Standard Single-Spot Photocoagulation for Diabetic Retinopathy

et al. 2018

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Objective: To compare two different laser strategies of panretinal photocoagulation for diabetic retinopathy. Methods: Single-center, randomized study including 41 eyes treated with 577-nm multispot laser with a 20-ms pulse duration (group 1) or a 532-nm single-spot laser with a 100-ms pulse duration (group 2). The outcomes included best-corrected visual acuity (BCVA) and imaging changes at baseline, 6 and 12 months, laser parameters, and results of subjective pain analysis. Results: At 12 months, the treatments did not differ significantly in BCVA, central retinal thicknesses (CRTs), improved macular edema, vitreomacular interface changes, patient-reported pain scores, or angiographic responses. Group 1 had significantly fewer treatment sessions but used more laser spots (p < 0.001). Conclusion: The multispot laser required fewer applications with more spots delivered to compensate for lower fluency, showing similar patient tolerance to single-spot laser. Both groups maintained the initial visual acuities and CRTs; about 50% of cases had vitreomacular interface changes and improved macular edema, with similar angiographic improvements after 12 months.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of 577-nm Multispot and Standard Single-Spot Photocoagulation for Diabetic Retinopathy

et al. 2018

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“…1,2 Our understanding of diabetic retinal diseases is primarily based on the evaluation of posterior retina. 1,2 Our understanding of diabetic retinal diseases is primarily based on the evaluation of posterior retina.…”

Section: Introductionmentioning

confidence: 99%

Region‐specific ischemia, neovascularization and macular oedema in treatment‐naïve proliferative diabetic retinopathy

Lange

Hadziahmetovic

Zhang

et al. 2018

Clinical Exper Ophthalmology

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The region-specific correlation of NPI of far-periphery and NVI of mid-periphery, but not with central retinal thickness, suggests different pathogeneses of neovascularization and macular oedema. Retinal nerve fibre layer and GCL, both biomarkers of diabetic retinal neuronopathy, are associated with retinal ischemia, but not with macular oedema, suggesting that diabetic microangiopathy and neuronopathy possess distinct pathogenic pathways. The strong correlation between macular oedema and INL indicates that intracellular oedema is a determining factor of diabetic macular oedema.

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“…Anti-VEGF agents may also help in retinal neovascularisation and NVD related to retinal ischaemia as in proliferative diabetic retinopathy. Recently, ranibizumab8 and aflibercept9 have been shown to be non-inferior to panretinal photocoagulation with regard to visual acuity outcomes in proliferative diabetic retinopathy. Though the results of success using intravitreal bevacizumab for inflammatory NVD have been reported,2 3 we could not find any prior reports using intravitreal ranibizumab for the same indication.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory optic disc neovascularisation managed with oral steroids/immunosuppressants and intravitreal ranibizumab

et al. 2017

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Inflammatory optic disc neovascularisation (NVD) has been treated with periocular or systemic steroids, immunosuppressants, panretinal photocoagulation and bevacizumab. However, the role of intravitreal ranibizumab in inflammatory NVD has not been explored in the peer-reviewed indexed literature. In case 1, NVD and associated subhyaloid haemorrhage showed rapid and dramatic regression after intravitreal ranibizumab. Recurrence was noted 8 weeks after injection which was managed by oral steroids. In case 2, intravitreal ranibizumab led to partial resolution of NVD. The addition of steroids, azathioprine and panretinal photocoagulation led to further fibrosis of the neovascularisation. Ranibizumab may be an important adjunct to anti-inflammatory therapy in the management of inflammatory NVD.

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Clinical efficacy of intravitreal aflibercept versus panretinal photocoagulation for best corrected visual acuity in patients with proliferative diabetic retinopathy at 52 weeks (CLARITY): a multicentre, single-blinded, randomised, controlled, phase 2b, non-inferiority trial

Cited by 323 publications

References 20 publications

Comparison of 577-nm Multispot and Standard Single-Spot Photocoagulation for Diabetic Retinopathy

Comparison of 577-nm Multispot and Standard Single-Spot Photocoagulation for Diabetic Retinopathy

Region‐specific ischemia, neovascularization and macular oedema in treatment‐naïve proliferative diabetic retinopathy

Inflammatory optic disc neovascularisation managed with oral steroids/immunosuppressants and intravitreal ranibizumab

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