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Intravitreal ranibizumab alone or in combination with panretinal photocoagulation for the treatment of proliferative diabetic retinopathy with coexistent macular edema: long-term outcomes of a prospective study

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Abstract

Aims

To compare intravitreal ranibizumab as monotherapy or in combination with panretinal photocoagulation (PRP) in patients with proliferative diabetic retinopathy (PDR) and coexistent diabetic macular edema (DME) in a long-term follow-up of 24 months.

Methods

Participants in this prospective study were 47 patients with PDR and concurrent DME, who were randomized at baseline into two groups: (i) the “ranibizumab alone” group (n = 23), which was treated with at least 3 intravitreal ranibizumab injections as a loading phase, and (ii) the “combination” group (n = 24), which was treated with PRP and at least 3 intravitreal ranibizumab injections. Thereafter, all patients were followed up at a pro re nata (PRN) basis, with regular monthly monitoring for 24 months. At each visit, best corrected visual acuity (BCVA) and spectral domain-optical coherence tomography were performed, while regression of neovascularization was also recorded.

Results

The “combination” group had better control of neovascularization and less events of vitreous hemorrhage than ranibizumab alone through the 2 years. BCVA did not differ significantly between the two groups at months 12 and 24 of the follow-up. The “ranibizumab” alone group presented greater reduction in central retinal thickness at month 12, which did not reach significance at month 24 compared to “combination” group. Greater number of injections was needed in the monotherapy group (mean 14 injections) compared to “combination” group (mean 11 injections) through month 24.

Conclusions

Both intravitreal ranibizumab alone or in combination with PRP could be used effectively for the treatment of PDR and coexistent DME. Even though there was no difference in BCVA and CRT at the 24-month follow-up between the two groups, the combination group presented greater regression of neovascularization with less injections.

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Funding

No funding was received for this research.

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Authors and Affiliations

  1. 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece

    Irini Chatziralli, Eleni Dimitriou, George Theodossiadis, Dimitrios Kazantzis & Panagiotis Theodossiadis

  2. Attikon University Hospital, 1, Rimini Street, 12462, Haidari, Greece

    Irini Chatziralli

Authors
  1. Irini Chatziralli
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  2. Eleni Dimitriou
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  3. George Theodossiadis
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  4. Dimitrios Kazantzis
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  5. Panagiotis Theodossiadis
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Contributions

IC conceived and designed the study, collected and interpreted data, performed the statistical analysis and drafted the manuscript; ED and DK collected data; GT interpreted data and critically revised the manuscript; PT had the supervision of the study and critically revised the manuscript. All authors have read and approved the current version of the manuscript.

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Correspondence to Irini Chatziralli.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, educational grants or other equity interest), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical standard statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Board of Attikon Hospital, Athens, Greece (ebd301/2015).

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All participants gave written informed consent for participation in the study.

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This article belongs to the topical collection Eye Complications of Diabetes, managed by Giuseppe Querques.

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Chatziralli, I., Dimitriou, E., Theodossiadis, G. et al. Intravitreal ranibizumab alone or in combination with panretinal photocoagulation for the treatment of proliferative diabetic retinopathy with coexistent macular edema: long-term outcomes of a prospective study. Acta Diabetol 57, 1219–1225 (2020). https://doi.org/10.1007/s00592-020-01548-y

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