Panretinal Photocoagulation Versus Ranibizumab for Proliferative Diabetic Retinopathy: Patient-Centered Outcomes From a Randomized Clinical Trial

Abstract

Purpose Compare patient-centered outcomes in patients with proliferative diabetic retinopathy (PDR) treated with ranibizumab versus panretinal photocoagulation (PRP). Design Randomized clinical trial. Methods Setting: Multicenter (55 US sites). Patient Population: 216 adults with one study eye out of 305 adults (excluding participants with two study eyes since each eye received a different treatment) with PDR, visual acuity 20/320 or better, no history of PRP. Intervention: Ranibizumab (0.5-mg/0.05mL) versus PRP. Main Outcome Measures: Change from baseline to 2 years in composite and pre-specified subscale scores from the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25), University of Alabama Low Luminance Questionnaire (UAB-LLQ), Work Productivity and Activity Impairment Questionnaire (WPAIQ). Results For the NEI VFQ-25 and UAB-LLQ composite scores, ranibizumab-PRP treatment group differences (95% CI) were +4.0 (−0.2, +8.3, P=0.06) and +1.8 (−3.5, +7.1, P=0.51) at 1 year, and +2.9 (−1.5, +7.2, P=0.20) and +2.3 (−2.9, +7.5, P=0.37) at 2 years, respectively. Work productivity loss measured with the WPAIQ was 15.6% less with ranibizumab (−26.3%, −4.8%, P=0.005) at 1 year and 2.9% (−12.2%, +6.4%, P=0.54) at 2 years. Eighty-three ranibizumab participants (97%) were 20/40 or better in at least one eye (visual acuity requirement to qualify for an unrestricted driver license in many states) at 2 years compared with 82 PRP participants (87%, adjusted risk ratio=1.1, 95% CI: 1.0, 1.2 P=0.005). Conclusions While differences in some work productivity and driving-related outcomes favored ranibizumab over PRP, no differences between treatment regimens for PDR were identified for most of the other patient-centered outcomes considered.

Boswellic acids ameliorate doxorubicin-induced nephrotoxicity in mice: a focus on antioxidant and antiapoptotic effects

“…Cells are naturally provided with antioxidant mechanisms protecting them from ROS activity in order to keep a balanced internal milieu. However, in critical situations such as oxidative stress, these mechanisms are not sufficient and fail to keep the balance [9]. Thus, exogenous antioxidants are suggested to have a protective and/or curative role against ROSinduced cytotoxicity.…”

Anti-Vascular Endothelial Growth Factor Therapy as an Alternative or Adjunct to Pan-Retinal Photocoagulation in Treating Proliferative Diabetic Retinopathy: Meta-Analysis of Randomized Trials

“…Nevertheless, the follow-up durations of these studies were no more than 48 weeks, reminding us that researches on long-term outcomes are necessary. No difference was identified between the two treatment regimens for PDR in most of the patient-centered outcomes (Beaulieu et al, 2016). The unique 5-year study reported the similar outcome of visual acuity in most eyes of PRP and anti-VEGF monotherapy (Gross et al, 2018).…”

Novel strategy for screening of diabetic retinopathy

“…Another point to consider is that recent prevalent use of anti‐VEGF and anti‐inflammatory drugs might be changing the definition of diabetic retinopathy that requires treatment. Emerging data show that anti‐VEGF and glucocorticoid therapies can reverse diabetic retinopathy, and even work better than panretinal and focal macular photocoagulation. Thus, screening algorithms and intervals might be better focused on more subclinical stages and entirely different in the future.…”