Intravitreal Ranibizumab in Diabetic Macular Edema: Long-Term Outcomes

Abstract

Intravitreal ranibizumab (RBZ) has been shown in multiple randomized clinical trials to be a valuable treatment for diabetic macular edema (DME), promoting a significant improvement in best-corrected visual acuity (BCVA) and in anatomic outcomes. Compared to sham (RISE and RIDE studies), RBZ rapidly and sustainably improved BCVA and decreased macular edema at 2 years, reducing the risk of further vision loss, with low rates of local or systemic side effects. Compared to macular laser photocoagulation (READ-2 study), RBZ provided a greater improvement in BCVA and regression in foveal thickness, but required a higher number of injections compared to patients treated with both RBZ and laser. In RESTORE trial, RBZ alone or combined with macular laser turned out to be superior to laser alone, without significant differences between the 2 RBZ groups. Compared to combined treatment (RBZ or triamcinolone associated with macular laser) or photocoagulation laser alone (Diabetic Retinopathy Clinical Research Network trial), RBZ with prompt or deferred laser was more effective than laser alone at 1-year follow-up. At 3 years, prompt laser was not better than deferring laser for 24 weeks or more. At 5 years, subjects treated with RBZ achieved better long-term visual outcomes than patients managed with triamcinolone or laser followed by very deferred RBZ. In conclusion, randomized clinical trials showed that RBZ was superior to laser in DME treatment, providing excellent long-term visual outcomes. Frequent injections were necessary in most of the patients to properly control DME and maximize the visual benefits.

Treatment of Diabetic Macular Edema with Intravitreal Antivascular Endothelial Growth Factor and Prompt versus Deferred Focal Laser during Long-Term Follow-Up and Identification of Prognostic Retinal Markers

“…Previous findings [ 14 – 16 ] are in accordance with the results of our study, signifying consistency of the treatment regimen.…”

“…To conclude, the study presented here showed that combined treatment with ranibizumab and focal laser effectively reduces visual loss due to DME, which is a major sight-threatening cause in diabetic patients. Our results regarding functional long-term development are in conjunction with those of several previous clinical trials [ 7 – 9 , 14 – 16 ] that evaluate the efficacy of anti-VEGF and laser treatment in DR, favoring anti-VEGF. Nevertheless, macular laser can still be applied and seems particularly favorable in the beginning of the treatment phase.…”

“…Furthermore, the effectivity of intravitreal anti-VEGF combined with laser has been shown in the Diabetic Retinopathy Clinical Research Network trial at the 1-year of follow-up. At 3 years, prompt laser was not better compared with deferring laser for 24 weeks or more [ 16 ].…”

Efficacy of intravitreal injection of conbercept on non-proliferative diabetic retinopathy: a retrospective study

“…25 Intravitreal injection of ranibizumab is also regarded as an effective treatment for diabetic retinopathy because it can significantly improve BCVA in affected patients. 26 In addition, Gross et al 27 showed that anti-VEGF therapy could reduce the severity of diabetic retinopathy; moreover, the therapeutic effect was superior to that of panretinal photocoagulation for at least 2 years. Conbercept is a new type of anti-VEGF drug that can bind to all subtypes of VEGF; 28 it also exhibits high affinity and strong durability.…”

Impact on visual acuity and psychological outcomes of ranibizumab and subsequent treatment for diabetic macular oedema in Japan (MERCURY)

“…DME is a long-term condition that places a considerable burden on patients and raises several questions regarding optimal treatment. Repeated intravitreal injections are generally required to maintain improved VA in DME patients [ 22 ]. However, the standard criteria for defining stability of VA and disease activity, including guidance for the timing of initiation, interruption and retreatment of ocular anti-VEGF agents, are still not well characterised.…”