Intravitreal Bevacizumab Plus Grid Laser Photocoagulation or Intravitreal Bevacizumab or Grid Laser Photocoagulation for Diffuse Diabetic Macular Edema

Arévalo, J. Fernando; Lasave, Andrés F.; Wu, Lihteh; Díaz-Llopis, M.; Gallego-Pinazo, Roberto; Alezzandrini, Arturo; Berrocal, María H.

doi:10.1097/iae.0b013e3182695b83

Cited by 45 publications

(35 citation statements)

References 31 publications

(28 reference statements)

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“…In the Protocol T, to achieve a totally dry macula, laser needed to be done after six months of intravitreal therapy in 41%, 52%, or 64% of the patients treated with aflibercept, ranibizumab, or bevacizumab, respectively. However, in a meta-analysis of 12–36 months of follow-up studies, no differences were found in this regard between ranibizumab monotherapy and combined with laser [32], and in a multicentric study comparing bevacizumab monotherapy versus combination with laser, bevacizumab showed better functional and anatomic results at 24 months than combination therapy [33]. …”

Section: Discussionmentioning

confidence: 99%

Combination of Anti-VEGF and Laser Photocoagulation for Diabetic Macular Edema: A Review

Distéfano

García-Arumí

Martínez-Castillo

et al. 2017

Journal of Ophthalmology

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Diabetic macular edema (DME) is the most common cause of vision loss in diabetic patients. Thirty years ago, the Early Treatment Diabetic Retinopathy Study (ETDRS) demonstrated that focal/grid laser photocoagulation reduces moderate vision loss from DME by 50% or more; thus, macular photocoagulation became the gold standard treatment for DME. However, with the development of anti-VEGF drugs (bevacizumab, ranibizumab, and aflibercept), better outcomes were obtained in terms of visual acuity gain and decrease in macular thickness in some studies when antiangiogenic drugs were administered in monotherapy. Macular laser therapy may still play an important role as an adjuvant treatment because it is able to improve macular thickness outcomes and reduce the number of injections needed. Here, we review some of the clinical trials that have assessed the efficacy of macular laser treatment, either as part of the treatment protocol or as rescue therapy.

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Section: Discussionmentioning

confidence: 99%

Combination of Anti-VEGF and Laser Photocoagulation for Diabetic Macular Edema: A Review

Distéfano

García-Arumí

Martínez-Castillo

et al. 2017

Journal of Ophthalmology

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“…The 2-year follow-up demonstrated the beneficial effect of IVB with or without grid laser photocoagulation for diffuse DME. [5960]…”

Section: Emerging Therapiesmentioning

confidence: 99%

Evolving strategies in the management of diabetic retinopathy

El‐Asrar

2013

Middle East Afr J Ophthalmol

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Diabetic retinopathy (DR), the most common long-term complication of diabetes mellitus, remains one of the leading causes of blindness worldwide. Tight glycemic and blood pressure control has been shown to significantly decrease the risk of development as well as the progression of retinopathy and represents the cornerstone of medical management of DR. The two most threatening complications of DR are diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Focal/grid photocoagulation and panretinal photocoagulation are standard treatments for both DME and PDR, respectively. Focal/grid photocoagulation is a better treatment than intravitreal triamcinolone acetonide in eyes with DME. Currently, most experts consider combination focal/grid laser therapy and pharmacotherapy with intravitreal antivascular endothelial growth factor agents in patients with center-involving DME. Combination therapy reduces the frequency of injections needed to control edema. Vitrectomy with removal of the posterior hyaloid seems to be effective in eyes with persistent diffuse DME, particularly in eyes with associated vitreomacular traction. Emerging therapies include fenofibrate, ruboxistaurin, renin-angiotensin system blockers, peroxisome proliferator-activated receptor gamma agonists, pharmacologic vitreolysis, and islet cell transplantation.

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“…Three commonly used intravitreous VEGF inhibitors — aflibercept (Eylea, Regeneron Pharmaceuticals), bevacizumab (Avastin, Genentech), and ranibizumab (Lucentis, Genentech) — have been shown to be beneficial and relatively safe for the treatment of diabetic macular edema, 6,15–18 but only aflibercept and ranibizumab are approved by the Food and Drug Administration (FDA) for this indication. Bevacizumab, which is not approved by the FDA for any ocular indication, is widely used for off-label treatment of diabetic macular edema in repackaged aliquots containing approximately 1/500th of the systemic dose used in cancer therapy.…”

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confidence: 99%

Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema

et al. 2015

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BACKGROUND The relative efficacy and safety of intravitreous aflibercept, bevacizumab, and ranibizumab in the treatment of diabetic macular edema are unknown. METHODS At 89 clinical sites, we randomly assigned 660 adults (mean age, 61±10 years) with diabetic macular edema involving the macular center to receive intravitreous aflibercept at a dose of 2.0 mg (224 participants), bevacizumab at a dose of 1.25 mg (218 participants), or ranibizumab at a dose of 0.3 mg (218 participants). The study drugs were administered as often as every 4 weeks, according to a protocol-specified algorithm. The primary outcome was the mean change in visual acuity at 1 year. RESULTS From baseline to 1 year, the mean visual-acuity letter score (range, 0 to 100, with higher scores indicating better visual acuity; a score of 85 is approximately 20/20) improved by 13.3 with aflibercept, by 9.7 with bevacizumab, and by 11.2 with ranibizumab. Although the improvement was greater with aflibercept than with the other two drugs (P<0.001 for aflibercept vs. bevacizumab and P = 0.03 for aflibercept vs. ranibizumab), it was not clinically meaningful, because the difference was driven by the eyes with worse visual acuity at baseline (P<0.001 for interaction). When the initial visual-acuity letter score was 78 to 69 (equivalent to approximately 20/32 to 20/40) (51% of participants), the mean improvement was 8.0 with aflibercept, 7.5 with bevacizumab, and 8.3 with ranibizumab (P>0.50 for each pairwise comparison). When the initial letter score was less than 69 (approximately 20/50 or worse), the mean improvement was 18.9 with aflibercept, 11.8 with bevacizumab, and 14.2 with ranibizumab (P<0.001 for aflibercept vs. bevacizumab, P = 0.003 for aflibercept vs. ranibizumab, and P = 0.21 for ranibizumab vs. bevacizumab). There were no significant differences among the study groups in the rates of serious adverse events (P = 0.40), hospitalization (P = 0.51), death (P = 0.72), or major cardiovascular events (P = 0.56). CONCLUSIONS Intravitreous aflibercept, bevacizumab, or ranibizumab improved vision in eyes with center-involved diabetic macular edema, but the relative effect depended on baseline visual acuity. When the initial visual-acuity loss was mild, there were no apparent differences, on average, among study groups. At worse levels of initial visual acuity, aflibercept was more effective at improving vision. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01627249.)

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Intravitreal Bevacizumab Plus Grid Laser Photocoagulation or Intravitreal Bevacizumab or Grid Laser Photocoagulation for Diffuse Diabetic Macular Edema

Cited by 45 publications

References 31 publications

Combination of Anti-VEGF and Laser Photocoagulation for Diabetic Macular Edema: A Review

Combination of Anti-VEGF and Laser Photocoagulation for Diabetic Macular Edema: A Review

Evolving strategies in the management of diabetic retinopathy

Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema

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