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Injection instead of laser for diabetic retinopathy

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Treating diabetes retinopathy patients with an injection of the drug ranibizumab is no less effective at maintaining clarity of vision than standard laser treatment, according to US researchers.

They found that, among patients with proliferative diabetic retinopathy, an injection in the eye with ranibizumab – an anti-vascular endothelial growth factor agent (anti-VEGF) – resulted in visual acuity that was not worse than panretinal photocoagulation at two years.

“Ranibizumab may be a reasonable treatment alternative at least through two years for patients with proliferative diabetic retinopathy”

Study authors

Panretinal photocoagulation with a laser is the standard treatment for reducing severe visual loss from proliferative diabetic retinopathy, the leading cause of vision loss in patients with diabetes.

However, it can cause permanent peripheral visual field loss and decreased night vision and may exacerbate diabetic macular oedema.

The study authors suggested that injecting anti-VEGF agents into the fluid behind the lens in the eye reduced the risk of diabetic retinopathy worsening and increased the chance of improvement, making them a potentially viable treatment.

Adam Glassman, from the Jaeb Center for Health Research in Florida and colleagues conducted a study that included 305 adults with proliferative diabetic retinopathy at 55 sites.

Individual eyes were randomly assigned to receive laser treatment, completed in one to three visits, or the anti-VEGF agent ranibizumab at the start of the study and as frequently as every four weeks afterwards based on a treatment protocol.

The researchers found that ranibizumab did not result in worse outcomes than the laser group, with no statistically significant visual acuity difference between the groups at two years.

The study authors said: “Although longer-term follow-up is needed, ranibizumab may be a reasonable treatment alternative at least through two years for patients with proliferative diabetic retinopathy.”

The study, published in the Journal of the American Medical Association, is being released to coincide with a presentation of the trial data at the American Academy of Ophthalmology annual meeting.

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