Gross JG, et al. - Authors evaluated the effectiveness and safety of 0.5-mg intravitreous ranibizumab vs panretinal photocoagulation (PRP) over 5 years for proliferative diabetic retinopathy (PDR). Nonetheless, they noted a relatively high loss to follow-up, there was very good visual acuity in most study eyes that completed follow-up at 5 years and was similar in both groups. With PRP or ranibizumab, severe vision loss or serious PDR complications were uncommon. Nonetheless, lower rates of developing vision-impairing diabetic macular edema and less visual field loss were seen in the ranibizumab group. While choosing treatment for patients with PDR, a consideration of patient-specific factors, including anticipated visit compliance, cost, and frequency of visits was suggested. Either anti–vascular endothelial growth factor therapy or PRP was supported as viable treatments for patients with PDR.

Methods

• In this Diabetic Retinopathy Clinical Research Network multicenter randomized clinical trial, experts evaluated 394 study eyes with PDR enrolled February through December 2012.
• They began the analysis in January 2018.
• They randomly assigned the eyes to receive intravitreous ranibizumab (n=191) or PRP (n=203), the frequency of ranibizumab was based on a protocol-specified retreatment algorithm.
• In either group, diabetic macular edema could be managed with ranibizumab.
• The main outcome included the mean change in visual acuity (intention-to-treat analysis).
• Peripheral visual field loss, development of vision-impairing diabetic macular edema, and ocular and systemic safety were included in secondary outcomes.

Results

• As per data, the 5-year visit was completed by 184 of 277 participants (66% excluding deaths).
• Findings suggested that out of 305 enrolled participants, the mean (SD) age was 52 (12) years, 135 (44%) were women, and 160 (52%) were white.
• Over 5 years, the mean (SD) number of injections for the ranibizumab and PRP groups, was 19.2 (10.9) and 5.4 (7.9), respectively; the mean (SD) change in visual acuity letter score was 3.1 (14.3) and 3.0 (10.5) letters, respectively (adjusted difference,-0.6; 95% CI, -2.3 to 3.5; P=.68); the mean visual acuity was 20/25 (approximate-Snellen equivalent) in both groups at 5 years.
• Results demonstrated that the mean (SD) change in cumulative visual field total point score was -330 (645) vs -527 (635) dB in the ranibizumab (n=41) and PRP (n=38) groups, respectively (adjusted difference, 208 dB; 95% CI, 9-408).
• In the ranibizumab and PRP groups, vision-impairing diabetic macular edema developed in 27 and 53 eyes, respectively (cumulative probabilities: 22% vs 38%; hazard ratio, 0.4; 95% CI, 0.3-0.7).
• Experts did not identify any statistically significant differences between groups in major systemic adverse event rates.