Long-term Effects of Therapy with Ranibizumab on Diabetic Retinopathy Severity and Baseline Risk Factors for Worsening Retinopathy

Abstract

Ranibizumab, as administered to patients with DME for 12 to 36 months in these studies, can both improve DR severity and prevent worsening. Prolonged delays in initiation of ranibizumab therapy may limit this therapeutic effect. Although uncommon, the development of PDR still occurs in a small percentage of eyes undergoing anti-vascular endothelial growth factor therapy and may be related to the presence of macular nonperfusion.

The Evaluation of Diabetic Macular Ischemia Using Optical Coherence Tomography Angiography

“…3 We believe that once our findings have been validated in larger prospective trials, clinicians will monitor DMI with OCT angiography rather than conventional FA.…”

“…2 More recently, an analysis of the RIDE and RISE trials showed that patients with DMI at baseline progressed earlier to neovascular complications of DR during intravitreal ranibizumab treatment than those with normal perfusion at baseline. 3 Therefore, baseline assessment of DMI when initiating ranibizumab therapy for diabetic macular edema (DME) has clinical implications and may be of practical importance to patients and physicians when planning review schedules for reassessment of peripheral retinopathy grades for patients receiving injections.…”

“…2,4,5 Assessing the level of macular ischemia in an individual can often provide important clinical and prognostic information for the clinician in regard to disease severity and progression. 3,5,6 However, despite its clinical usefulness, FA is acknowledged to have documented risks that include nausea, vomiting, itching and urticaria, and rarely, anaphylaxis.7 In recent years, optical coherence tomography (OCT) has become widely accepted as a noninvasive means of acquiring high-resolution images of the retina that can be utilized in the treatment of retinal disease. 4 The recent development of OCT angiography allows for the visualization of the retinal capillary layers and for the construction of microvascular flow maps.…”

Automated Quantification of Capillary Nonperfusion Using Optical Coherence Tomography Angiography in Diabetic Retinopathy

“…1-5 In the age of antivascular endothelial growth factor therapy for DR, the assessment of macular ischemia may become more important because the effects of antivascular endothelial growth factor therapy can obscure clinical findings that predict the risk of progression. 23 Fluorescein angiography has been the primary method for evaluating macular ischemia, but it has limitations. The contrast varies with the timing of dye injection, the degree of pigmentation, and media opacity.…”

Outcomes of intravitreal anti-VEGF therapy in eyes with both neovascular age-related macular degeneration and diabetic retinopathy

“…Aflibercept (Eylea, Regeneron-Bayer HealthCare), a new, fully human recombinant fusion protein designed to bind all isoforms of VEGF-A as well as placental growth factor, thereby inhibiting the binding and activation of VEGF receptors, has been also approved for AMD and DMO treatment 8. Recently, the potential for anti-VEGF agents to reduce DR severity has been demonstrated;9 these agents are being evaluated for the treatment of vitreous haemorrhage due to proliferative DR (PDR) 10…”