Ranibizumab for High-Risk Proliferative Diabetic Retinopathy: An Exploratory Randomized Controlled Trial

Abstract

Purpose: To compare the efficacy and safety of intravitreal ranibizumab (IVR) in monotherapy or associated with panretinal photocoagulation (PRP) versus conventional PRP, for high-risk proliferative diabetic retinopathy (PDR) without vitreoretinal traction. Procedures: Multicenter randomized trial, with 3 treatment arms: PRP versus IVR alone and PRP + IVR combined treatment. Follow-up was performed at months 3, 6 and 12. Results: Thirty-five subjects were randomized and 32 used for analysis. Complete regression of neovessels elsewhere occurred in 100% (PRP + IVR), 75% (IVR) and 69.2% (PRP) and for neovessels of the disk in 44.4% (PRP + IVR), 37.5% (IVR) and 30.8% (PRP). During the 1-year duration of treatment, there was no need for laser rescue treatment in IVR-treated eyes. Conclusions: This trial suggests that the use of IVR is safe and may have a beneficial effect in the treatment of eyes with high-risk PDR. Message: Ranibizumab appears to have a place in the treatment of PDR.

Panretinal Photocoagulation vs. Panretinal Photocoagulation Plus Intravitreal Ranibizumab in High-Risk Proliferative Diabetic Retinopathy

“…The results of the current study are consistent with data from other studies [8][9][10][11][12] regarding the absence of any apparent association between intravitreal ranibizumab injection and increased IOP, cataract development or progression or increased rates of endophthalmitis related to the study drug.…”

“…In our study group, patients had a mean age of presentation in PRP group is 61 years in PRP group and 58 years in PRP plus group, which was comparable to the mean age in the study by Filho et al⁸ (63.3 years in PRP group and 50.5 in PRP plus group), Panshi et al⁹ (66.3 years), Josef et al 10 (65 years in PRP group and 64 years in PRP plus group), Fequira et al 11 (60 years in PRP group and 62 years in PRP plus group) and Daniel et al 12 (56 years in PRP group and 59 years in PRP plus group). Most of our patients were males (21, 58.33%), which is similar in other studies.…”

Time-dependent changes in hypoxia- and gliosis-related factors in experimental diabetic retinopathy

“…VEGF has long been known to contribute to angiogenesis and increase the permeability of the vascular endothelium. Anti-VEGF therapy aimed at preventing macular oedema and retinal neovascularisation has been widely used, and it has produced satisfactory results [48–51]. EPO is still being considered a “two-faced Janus” factor in the retina where it acts by binding to a trans-membrane receptor (EPOR).…”

The CURRENT TRENDS AND TREATMENTS IN DIABETIC RETINOPATHY

“…There are different types of study that has been considered and shows about 25-45% of disease which can be treated with increased macular edema and the disturbances in the eyes [51]. The intravitreal injection of the anti-VEGF of the drug which has been considered with the choice to PDR treatment [52].…”