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Panretinal Photocoagulation Versus Ranibizumab for Proliferative Diabetic Retinopathy: Factors Associated with Vision and Edema Outcomes.
Ophthalmology. 2018 11; 125(11):1776-1783.O

Abstract

PURPOSE

To identify baseline factors associated with change in visual acuity or development of vision-impairing central-involved diabetic macular edema (DME) over 2 years when treating proliferative diabetic retinopathy (PDR) with ranibizumab or panretinal photocoagulation (PRP).

DESIGN

Post hoc analyses of randomized, multicenter clinical trial data.

PARTICIPANTS

Eyes completing the 2-year visit (n = 328) or without vision-impairing central-involved DME at baseline (n = 302) in Diabetic Retinopathy Clinical Research Network Protocol S.

METHODS

Intravitreous ranibizumab (0.5 mg/0.05 ml) or PRP.

MAIN OUTCOME MEASURES

Change in visual acuity (area under the curve) and development of vision-impairing (20/32 or worse) central-involved DME over 2 years.

RESULTS

After multivariable model selection with adjustment for baseline visual acuity and central subfield thickness, no factors were identified as associated with change in visual acuity or development of vision-impairing central-involved DME within the ranibizumab group. In the PRP group, worse change in visual acuity was more likely with higher hemoglobin A1c level (-0.6 letters per 1% increase; 95% confidence interval [CI], -1.2 to -0.1 letters; continuous P = 0.03), more severe diabetic retinopathy (difference between high-risk PDR or worse vs. moderate PDR or better, -2.8 letters [95% CI, -5.5 to -0.2 letters]; continuous P = 0.003), and higher mean arterial pressure (difference between ≥100 mmHg vs. <100 mmHg, -2.0 letters [95% CI, -4.6 to 0.5 letters]; continuous P = 0.009). Development of vision-impairing central-involved DME was more likely with higher hemoglobin A1c level (hazard ratio [HR] per 1% increase, 1.31 [95% CI, 1.13-1.52]; continuous P < 0.001), more severe diabetic retinopathy (HR for high-risk PDR or worse vs. moderate PDR or better, 1.46 [95% CI, 0.73-2.92]; continuous P = 0.03), and the presence of cystoid abnormalities within 500 μm of the macula center (HR, 2.90 [95% CI, 1.35-6.24]; P = 0.006).

CONCLUSIONS

For eyes managed with PRP, higher hemoglobin A1c level and more severe diabetic retinopathy were associated with less vision improvement and an increased risk of vision-impairing central-involved DME developing. When managing PDR with ranibizumab, eyes gained vision, on average, with no baseline characteristics identified as associated with visual acuity or central-involved DME outcomes.

Authors+Show Affiliations

Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.Jaeb Center for Health Research, Tampa, Florida. Electronic address: drcrstat8@jaeb.org.Jaeb Center for Health Research, Tampa, Florida.Carolina Retina Center PA, Columbia, South Carolina.Jaeb Center for Health Research, Tampa, Florida.Retina Consultants of Houston, Houston, Texas.Family Eye Group, Lancaster, Pennsylvania.Feinberg School of Medicine, Northwestern University, Chicago, Illinois.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29980333

Citation

Bressler, Susan B., et al. "Panretinal Photocoagulation Versus Ranibizumab for Proliferative Diabetic Retinopathy: Factors Associated With Vision and Edema Outcomes." Ophthalmology, vol. 125, no. 11, 2018, pp. 1776-1783.
Bressler SB, Beaulieu WT, Glassman AR, et al. Panretinal Photocoagulation Versus Ranibizumab for Proliferative Diabetic Retinopathy: Factors Associated with Vision and Edema Outcomes. Ophthalmology. 2018;125(11):1776-1783.
Bressler, S. B., Beaulieu, W. T., Glassman, A. R., Gross, J. G., Melia, M., Chen, E., Pavlica, M. R., & Jampol, L. M. (2018). Panretinal Photocoagulation Versus Ranibizumab for Proliferative Diabetic Retinopathy: Factors Associated with Vision and Edema Outcomes. Ophthalmology, 125(11), 1776-1783. https://doi.org/10.1016/j.ophtha.2018.04.039
Bressler SB, et al. Panretinal Photocoagulation Versus Ranibizumab for Proliferative Diabetic Retinopathy: Factors Associated With Vision and Edema Outcomes. Ophthalmology. 2018;125(11):1776-1783. PubMed PMID: 29980333.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Panretinal Photocoagulation Versus Ranibizumab for Proliferative Diabetic Retinopathy: Factors Associated with Vision and Edema Outcomes. AU - Bressler,Susan B, AU - Beaulieu,Wesley T, AU - Glassman,Adam R, AU - Gross,Jeffrey G, AU - Melia,Michele, AU - Chen,Eric, AU - Pavlica,Michael R, AU - Jampol,Lee M, AU - ,, Y1 - 2018/07/03/ PY - 2018/02/27/received PY - 2018/04/24/revised PY - 2018/04/27/accepted PY - 2018/7/8/pubmed PY - 2019/9/14/medline PY - 2018/7/8/entrez SP - 1776 EP - 1783 JF - Ophthalmology JO - Ophthalmology VL - 125 IS - 11 N2 - PURPOSE: To identify baseline factors associated with change in visual acuity or development of vision-impairing central-involved diabetic macular edema (DME) over 2 years when treating proliferative diabetic retinopathy (PDR) with ranibizumab or panretinal photocoagulation (PRP). DESIGN: Post hoc analyses of randomized, multicenter clinical trial data. PARTICIPANTS: Eyes completing the 2-year visit (n = 328) or without vision-impairing central-involved DME at baseline (n = 302) in Diabetic Retinopathy Clinical Research Network Protocol S. METHODS: Intravitreous ranibizumab (0.5 mg/0.05 ml) or PRP. MAIN OUTCOME MEASURES: Change in visual acuity (area under the curve) and development of vision-impairing (20/32 or worse) central-involved DME over 2 years. RESULTS: After multivariable model selection with adjustment for baseline visual acuity and central subfield thickness, no factors were identified as associated with change in visual acuity or development of vision-impairing central-involved DME within the ranibizumab group. In the PRP group, worse change in visual acuity was more likely with higher hemoglobin A1c level (-0.6 letters per 1% increase; 95% confidence interval [CI], -1.2 to -0.1 letters; continuous P = 0.03), more severe diabetic retinopathy (difference between high-risk PDR or worse vs. moderate PDR or better, -2.8 letters [95% CI, -5.5 to -0.2 letters]; continuous P = 0.003), and higher mean arterial pressure (difference between ≥100 mmHg vs. <100 mmHg, -2.0 letters [95% CI, -4.6 to 0.5 letters]; continuous P = 0.009). Development of vision-impairing central-involved DME was more likely with higher hemoglobin A1c level (hazard ratio [HR] per 1% increase, 1.31 [95% CI, 1.13-1.52]; continuous P < 0.001), more severe diabetic retinopathy (HR for high-risk PDR or worse vs. moderate PDR or better, 1.46 [95% CI, 0.73-2.92]; continuous P = 0.03), and the presence of cystoid abnormalities within 500 μm of the macula center (HR, 2.90 [95% CI, 1.35-6.24]; P = 0.006). CONCLUSIONS: For eyes managed with PRP, higher hemoglobin A1c level and more severe diabetic retinopathy were associated with less vision improvement and an increased risk of vision-impairing central-involved DME developing. When managing PDR with ranibizumab, eyes gained vision, on average, with no baseline characteristics identified as associated with visual acuity or central-involved DME outcomes. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/29980333/Panretinal_Photocoagulation_Versus_Ranibizumab_for_Proliferative_Diabetic_Retinopathy:_Factors_Associated_with_Vision_and_Edema_Outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(18)30577-3 DB - PRIME DP - Unbound Medicine ER -