Panretinal Photocoagulation Versus Ranibizumab for Proliferative Diabetic Retinopathy: Factors Associated with Vision and Edema Outcomes

Diabetic Retinopathy Clinical Research Network

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalOphthalmology
DOIs
StateAccepted/In press - Jan 1 2018

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Light Coagulation
Diabetic Retinopathy
Edema
Macular Edema
Visual Acuity
Confidence Intervals
Hemoglobins
Ranibizumab
Clinical Protocols
Multicenter Studies
Area Under Curve
Arterial Pressure
Randomized Controlled Trials
Odds Ratio
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

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Panretinal Photocoagulation Versus Ranibizumab for Proliferative Diabetic Retinopathy : Factors Associated with Vision and Edema Outcomes. / Diabetic Retinopathy Clinical Research Network.

In: Ophthalmology, 01.01.2018.

Research output: Contribution to journalArticle

@article{e91c23be5b32491ab9e6940c459b747f,
title = "Panretinal Photocoagulation Versus Ranibizumab for Proliferative Diabetic Retinopathy: Factors Associated with Vision and Edema Outcomes",
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.",
author = "{Diabetic Retinopathy Clinical Research Network} and Bressler, {Susan B} and Beaulieu, {Wesley T.} and Glassman, {Adam R.} and Gross, {Jeffrey G.} and Michele Melia and Eric Chen and Pavlica, {Michael R.} and Jampol, {Lee M.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.ophtha.2018.04.039",
language = "English (US)",
journal = "Ophthalmology",
issn = "0161-6420",
publisher = "Elsevier Inc.",

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TY - JOUR

T1 - Panretinal Photocoagulation Versus Ranibizumab for Proliferative Diabetic Retinopathy

T2 - Factors Associated with Vision and Edema Outcomes

AU - Diabetic Retinopathy Clinical Research Network

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.

PY - 2018/1/1

Y1 - 2018/1/1

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.

AB - 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.

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