Diabetic Macular Edema: Changing Treatment Paradigms
Diabetic Macular Edema: Changing Treatment Paradigms
Several clinical reports have suggested that anti-VEGF therapies can cause transient regression of proliferative diabetic retinopathy (PDR). A secondary outcome was reported by the Diabetic Retinopathy Clinical Research Network (DRCR.net), and more recently, Ip et al. supported that ranibizumab may decrease the cumulative probability of worsening of diabetic retinopathy.
Bressler et al. conducted an exploratory analysis on worsening of retinopathy. This study found that for eyes without PDR at baseline, the 3-year cumulative probabilities for retinopathy worsening (P-value comparison with sham with prompt laser) were 23% using sham with prompt laser, 18% with ranibizumab with prompt laser (P = 0.25), 7% with ranibizumab with deferred laser (P = 0.001), and 37% with triamcinolone with prompt laser (P = 0.10). For eyes with PDR at baseline, the 3-year cumulative probabilities for retinopathy worsening were 40%, 21% (P = 0.05), 18% (P = 0.02), and 12% (P < 0.001), respectively. The authors concluded that intravitreal ranibizumab appears to be associated with a reduced risk of diabetic retinopathy worsening in eyes with or without PDR. Intravitreal triamcinolone also appears to be associated with a reduced risk of PDR worsening. These findings suggest that use of these drugs to prevent worsening of diabetic retinopathy may be feasible.
Given the exploratory nature of these analyses, the risk of endophthalmitis following intravitreal injections, and the fact that intravitreal triamcinolone can cause cataract or glaucoma, use of these treatments to reduce the rates of worsening of retinopathy, with or without PDR, does not seem warranted at this time.
Reduced Risk of Diabetic Retinopathy Worsening With Intravitreal Ranibizumab or Triamcinolone
Several clinical reports have suggested that anti-VEGF therapies can cause transient regression of proliferative diabetic retinopathy (PDR). A secondary outcome was reported by the Diabetic Retinopathy Clinical Research Network (DRCR.net), and more recently, Ip et al. supported that ranibizumab may decrease the cumulative probability of worsening of diabetic retinopathy.
Bressler et al. conducted an exploratory analysis on worsening of retinopathy. This study found that for eyes without PDR at baseline, the 3-year cumulative probabilities for retinopathy worsening (P-value comparison with sham with prompt laser) were 23% using sham with prompt laser, 18% with ranibizumab with prompt laser (P = 0.25), 7% with ranibizumab with deferred laser (P = 0.001), and 37% with triamcinolone with prompt laser (P = 0.10). For eyes with PDR at baseline, the 3-year cumulative probabilities for retinopathy worsening were 40%, 21% (P = 0.05), 18% (P = 0.02), and 12% (P < 0.001), respectively. The authors concluded that intravitreal ranibizumab appears to be associated with a reduced risk of diabetic retinopathy worsening in eyes with or without PDR. Intravitreal triamcinolone also appears to be associated with a reduced risk of PDR worsening. These findings suggest that use of these drugs to prevent worsening of diabetic retinopathy may be feasible.
Given the exploratory nature of these analyses, the risk of endophthalmitis following intravitreal injections, and the fact that intravitreal triamcinolone can cause cataract or glaucoma, use of these treatments to reduce the rates of worsening of retinopathy, with or without PDR, does not seem warranted at this time.
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