Randomized trial evaluating short-term effects of intravitreal ranibizumab or triamcinolone acetonide on macular edema after focal/grid laser for diabetic macular edema in eyes also receiving panretinal photocoagulation

Joseph Googe, Alexander J. Brucker, Neil M. Bressler, Haijing Qin, Lloyd P. Aiello, Andrew Antoszyk, Roy W. Beck, Susan B. Bressler, Frederick L. Ferris, Adam R. Glassman, Dennis Marcus, Cynthia R. Stockdale

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To evaluate 14-week effects of intravitreal ranibizumab or triamcinolone in eyes receiving focal/grid laser for diabetic macular edema and panretinal photocoagulation. Methods: Three hundred and forty-five eyes with a visual acuity of 20/320 or better, center-involved diabetic macular edema receiving focal/grid laser, and diabetic retinopathy receiving prompt panretinal photocoagulation were randomly assigned to sham (n = 123), 0.5-mg ranibizumab (n = 113) at baseline and 4 weeks, and 4-mg triamcinolone at baseline and sham at 4 weeks (n = 109). Treatment was at investigator discretion from 14 weeks to 56 weeks. Results: Mean changes (±SD) in visual acuity letter score from baseline were significantly better in the ranibizumab (+1 ± 11; P < 0.001) and triamcinolone (+2 ± 11; P < 0.001) groups compared with those in the sham group (-4 ± 14) at the 14-week visit, mirroring retinal thickening results. These differences were not maintained when study participants were followed for 56 weeks for safety outcomes. One eye (0.9%; 95% confidence interval, 0.02%-4.7%) developed endophthalmitis after receiving ranibizumab. Cerebrovascular/cardiovascular events occurred in 4%, 7%, and 3% of the sham, ranibizumab, and triamcinolone groups, respectively. Conclusion: The addition of 1 intravitreal triamcinolone injection or 2 intravitreal ranibizumab injections in eyes receiving focal/grid laser for diabetic macular edema and panretinal photocoagulation is associated with better visual acuity and decreased macular edema by 14 weeks. Whether continued long-term intravitreal treatment is beneficial cannot be determined from this study.

Original languageEnglish (US)
Pages (from-to)1009-1027
Number of pages19
JournalRetina
Volume31
Issue number6
DOIs
StatePublished - Jun 2011

Keywords

  • Diabetic Retinopathy Clinical Research Network
  • Proliferative diabetic retinopathy
  • diabetic macular edema
  • panretinal photocoagulation
  • randomized clinical trial
  • ranibizumab
  • triamcinolone

ASJC Scopus subject areas

  • Ophthalmology

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