Recent clinically relevant highlights from the Diabetic Retinopathy Clinical Research Network

Tracy W. Krick, Neil M Bressler

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose of review: To present some recent clinically relevant results from Diabetic Retinopathy Clinical Research (DRCR) Network trials that may guide management of diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR). Recent findings: Among eyes with DME and visual acuity 20/50 or worse, aflibercept, on average, had greater improvement in visual acuity over 2 years compared with bevacizumab or ranibizumab. Aflibercept is associated with higher rates of improvements in diabetic retinopathy severity among eyes with PDR and vision-impairing DME at baseline compared with bevacizumab or ranibizumab. Among eyes with persistent central-involved DME after at least six antivascular endothelial growth factor (anti-VEGF) injections, no difference in mean visual acuity improvement was observed between eyes that received continued ranibizumab and sham injections versus ranibizumab and intravitreous sustained dexamethasone drugdelivery system, especially for phakic eyes. For eyes with PDR, ranibizumab was associated with lower rates of developing PDR-worsening events compared with panretinal photocoagulation, especially among eyes that did not receive ranibizumab for central-involved DME at baseline. Ranibizumab is cost-effective for PDR for eyes with, not without, vision-impairing central-involved DME, highlighting challenges when safety and efficacy results are at odds with cost-effectiveness results. Summary: Aflibercept for DME, in certain circumstances, is more likely to have superior visual acuity and anatomical outcomes compared with bevacizumab or ranibizumab. No vision benefits are apparent, especially for phakic eyes, by adding intravitreous corticosteroids for persistent DME following anti-VEGF injections.

Original languageEnglish (US)
Pages (from-to)199-205
Number of pages7
JournalCurrent Opinion in Ophthalmology
Volume29
Issue number3
DOIs
StatePublished - May 1 2018

Keywords

  • Antivascular endothelial growth factor
  • Diabetic macular edema
  • Panretinal photocoagulation
  • Proliferative diabetic retinopathy

ASJC Scopus subject areas

  • Ophthalmology

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