Ranibizumab Plus Panretinal Photocoagulation versus Panretinal Photocoagulation Alone for High-Risk Proliferative Diabetic Retinopathy (PROTEUS Study)

Figueira, João; Fletcher, Emily; Massin, Pascale; Silva, Rufino; Bandello, Francesco; Midena, Edoardo; Varano, Monica; Sivaprasad, Sobha; Eleftheriadis, Haralabos; Menon, Geeta; Amaro, Miguel Hage; Scheer, S.; Creuzot‐Garcher, Catherine; Nascimento, João; Alves, Dalila; Nunes, Sandrina; Lobo, Conceição; Cunha-Vaz, Josè

doi:10.1016/j.ophtha.2017.12.008

Cited by 95 publications

(103 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As for BCVA changes, there was no statistically significant difference between the two groups at any visits, whereas significant visual acuity improvement was only observed in the PRP group at 3 months. Similar findings were reported by Figueira et al [5,7]. Possible explanations include the limited number of patients who had fairly good baseline visual acuity but were unassociated with DME.…”

Section: Discussionsupporting

confidence: 86%

“…Compared with the PRP group, the NVE reduction observed in the combination group was significantly larger at all study visits, suggesting that combination treatment could cause a quick and durable regression of retinal neovascular tissues. Although only one single dose of anti-VEGF was applied in this combination approach, it showed a synergistic effect with PRP causing an eventual reduction in NVE, as in previous studies using multiple injections [7], suggesting the combination approach to be a cost-effective choice for PDR patients. As for BCVA changes, there was no statistically significant difference between the two groups at any visits, whereas significant visual acuity improvement was only observed in the PRP group at 3 months.…”

Section: Discussionmentioning

confidence: 70%

“…According to the latest Diabetic Retinopathy Clinical Guidelines released by the American Academy of Ophthalmology in 2016 [4], PRP should be performed once the neovascularization (NV) appears, and intravitreal injection of anti-VEGF agents may be recommended until then. It has been confirmed by many authors that PRP combined with anti-VEGF agents, including ranibizumab and bevacizumab, is more effective than PRP alone for NV regression [5][6][7][8], but there has been no unified scheme across different studies. In addition, anti-VEGF medications are not commonly covered by medical insurance in China, which makes the repeated injection of such agents unaffordable for many patients.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Longitudinal neovascular changes on optical coherence tomography angiography in proliferative diabetic retinopathy treated with panretinal photocoagulation alone versus with intravitreal conbercept plus panretinal photocoagulation: a pilot study

2019

Eye

View full text Add to dashboard Cite

Purpose To investigate the longitudinal changes in neovascularization of the retinal elsewhere (NVE) size on optical coherence tomography angiography (OCTA) in proliferative diabetic retinopathy (PDR) treated by panretinal photocoagulation (PRP) alone or by single intravitreal conbercept injection plus PRP. Methods A prospective pilot study. Forty-four PDR eyes with NVE confirmed by fundus fluorescein angiography (FFA) and OCTA were included. They were assigned to receive PRP alone (PRP group) or intravitreal conbercept injection plus PRP (combination group). Ophthalmic examinations, including BCVA and OCTA to measure the NVE size, were performed at baseline before each PRP session, and at 1, 3, and 6 months. Results Twenty-nine eyes were included in the PRP group, and 15 eyes were included in the combination group. There was no significant difference between the two groups with respect to age, BCVA, and NVE area at baseline. In both groups, there was a significant (P < 0.05) NVE size reduction during the majority of study visits, with the reduction observed in the combination group significantly larger than that in the PRP group. No significant BCVA changes were observed in either groups, except that in the PRP group, the BCVA at 3 months was significantly improved (P < 0.05). No deaths or unexpected adverse events (AEs) were reported. Conclusions Intravitreal conbercept plus PRP was more effective than PRP monotherapy in NVE regression. Precise quantification of the NVE area by OCTA makes it a useful tool for monitoring the response of retinal neovascular lesions to the therapy.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Longitudinal neovascular changes on optical coherence tomography angiography in proliferative diabetic retinopathy treated with panretinal photocoagulation alone versus with intravitreal conbercept plus panretinal photocoagulation: a pilot study

2019

Eye

View full text Add to dashboard Cite

show abstract

“…In PDR, some reports have suggested that combination treatment with anti-VEGF and PRP may be superior to monotherapy in terms of NV regression and treatment burden. [170][171][172] As indicated earlier, recent data from protocol S of the DRCR Network demonstrated that both PRP and intravitreal ranibizumab were similar in the prevention of severe visual loss and other complications in PDR suggesting that patient-specific factors such as compliance and financial impact be considered primarily in management decisions. 123,173 Protocol I of the DRCR Network demonstrated that there was little short-term benefit in combining prompt macular laser with anti-VEGF therapy for centerinvolved DME.…”

Section: Integration Of Laser Therapy and Pharmacotherapymentioning

confidence: 80%

<p>The Evolving Treatment of Diabetic Retinopathy</p>

Mansour¹,

Browning²,

Wong³

et al. 2020

OPTH

177

119

View full text Add to dashboard Cite

Purpose: To review the current therapeutic options for the management of diabetic retinopathy (DR) and diabetic macular edema (DME) and examine the evidence for integration of laser and pharmacotherapy. Methods: A review of the PubMed database was performed using the search terms diabetic retinopathy, diabetic macular edema, neovascularization, laser photocoagulation, intravitreal injection, vascular endothelial growth factor (VEGF), vitrectomy, pars plana vitreous surgery, antiangiogenic therapy. With additional cross-referencing, this yielded 835 publications of which 301 were selected based on content and relevance. Results: Many recent studies have evaluated the pharmacological, laser and surgical therapeutic strategies for the treatment and prevention of DR and DME. Several newer diagnostic systems such as optical coherence tomography (OCT), microperimetry, and multifocal electroretinography (mfERG) are also assisting in further refinements in the staging and classification of DR and DME. Pharmacological therapies for both DR and DME include both systemic and ocular agents. Systemic agents that promote intensive glycemic control, control of dyslipidemia and antagonists of the renin-angiotensin system demonstrate beneficial effects for both DR and DME. Ocular therapies include anti-VEGF agents, corticosteroids and nonsteroidal anti-inflammatory drugs. Laser therapy, both as panretinal and focal or grid applications continue to be employed in management of DR and DME. Refinements in laser devices have yielded more tissue-sparing (subthreshold) modes in which many of the benefits of conventional continuous wave (CW) lasers can be obtained without the adverse side effects. Recent attempts to lessen the burden of anti-VEGF injections by integrating laser therapy have met with mixed results. Increasingly, vitreoretinal surgical techniques are employed for less advanced stages of DR and DME. The development and use of smaller gauge instrumentation and advanced anesthesia agents have been associated with a trend toward earlier surgical intervention for diabetic retinopathy. Several novel drug delivery strategies are currently being examined with the goal of decreasing the therapeutic burden of monthly intravitreal injections. These fall into one of the five categories: non-biodegradable polymeric drug delivery systems, biodegradable polymeric drug delivery systems, nanoparticle-based drug delivery systems, ocular injection devices and with sustained release refillable devices. At present, there remains no one single strategy for the management of the particular stages of DR and DME as there are many options that have not been rigorously tested through large, randomized, controlled clinical trials. Conclusion: Pharmacotherapy, both ocular and systemic, will be the primary mode of intervention in the management of DR and DME in many cases when cost and treatment burden are less constrained. Conventional laser therapy has become a secondary intervention in these instances, but remains a first-line option when cost and ...

show abstract

“…2) [53,54]. On the other hand, the Protocol S by the DRCR.net [55,56] and the PRO-TEUS study [57] have opened the door on alternative medical treatments for PDR, albeit requiring greater compliance and economical costs compared to traditional PRP. Upcoming trials with longer follow-up and multiethnic cohorts will better clarify the role of laser photocoagulation in DR and its combination with anti-VEGF treatments [56].…”

Section: Dr Classification and Laser Photocoagulationmentioning

confidence: 99%

19th EURETINA Congress Keynote Lecture: Diabetic Retinopathy Today

Bandello

Cicinelli

2020

Ophthalmologica

Self Cite

View full text Add to dashboard Cite

In the last decades, significant changes have been taking place regarding the pathogenesis of diabetic retinopathy (DR) and the complex mechanisms that eventually lead to the various manifestations of the disease, including diabetic macular edema (DME). DR was first considered a pure microvascular disease, due to the evident capillary structural changes (microaneurysms), fluid extravasation, and lipid exudation. With the advent of fundus fluorescein angiography, the concept of ischemia and the correlation between peripheral nonperfusion and neovascularization has been introduced, which was eventually followed by the advent of new therapeutic strategies, such as peripheral photocoagulation. Nowadays, thanks to more advanced imaging techniques, namely optical coherence tomography (OCT), OCT angiography, and wide-field imaging (imaging up to 200° of the retina in a single shot), it became clear that other elements participate in the occurrence of DR and DME, including inflamma-tion and neurodegeneration. In the future, integration of standard investigations with new diagnostic devices would allow the prompt recognition of DR even before clinical signs of the disease are ophthalmoscopically evident, and the development of personalized treatment for both retinopathy and DME will be available.

show abstract

Ranibizumab Plus Panretinal Photocoagulation versus Panretinal Photocoagulation Alone for High-Risk Proliferative Diabetic Retinopathy (PROTEUS Study)

Cited by 95 publications

References 26 publications

Longitudinal neovascular changes on optical coherence tomography angiography in proliferative diabetic retinopathy treated with panretinal photocoagulation alone versus with intravitreal conbercept plus panretinal photocoagulation: a pilot study

Longitudinal neovascular changes on optical coherence tomography angiography in proliferative diabetic retinopathy treated with panretinal photocoagulation alone versus with intravitreal conbercept plus panretinal photocoagulation: a pilot study

<p>The Evolving Treatment of Diabetic Retinopathy</p>

19th EURETINA Congress Keynote Lecture: Diabetic Retinopathy Today

Contact Info

Product

Resources

About