Early and Long-term Responses to Anti–Vascular Endothelial Growth Factor Therapy in Diabetic Macular Edema: Analysis of Protocol I Data

Abstract

In an important study, Gonzales and associates 1 Gonzalez V.H. Campbell J. Holekamp N.M. et al. Early and long-term responses to anti-vascular endothelial growth factor therapy in diabetic macular edema: analysis of protocol I data. Am J Ophthalmol. 2016; 172: 72-79 Abstract Full Text Full Text PDF PubMed Scopus (201) Google Scholar analyze the 3-year study data from patients in the Diabetic Retinopathy Clinical Research Network's Protocol I study 2 Elman M.J. Qin H. Aiello L.P. et al. DRCR.netIntravitreal ranibizumab for diabetic macular edema with prompt versus deferred laser treatment. Three-year randomized trial results. Ophthalmology. 2012; 119: 2312-2318 Abstract Full Text Full Text PDF PubMed Scopus (319) Google Scholar who were treated with ranibizumab plus prompt or deferred laser and provided an observed best-corrected visual acuity (BCVA) reading at 12 weeks. The analysis reveals that after 3-monthly ranibizumab injections plus prompt focal/grid laser treatment in part of the eyes, 40% (135/340) of diabetic macular edema (DME) eyes showed at best only limited BCVA gain (<5 letters). These include 12% (8%–16%) of eyes with visual worsening of 5 to ≥15 letters (Table 5 2 Elman M.J. Qin H. Aiello L.P. et al. DRCR.netIntravitreal ranibizumab for diabetic macular edema with prompt versus deferred laser treatment. Three-year randomized trial results. Ophthalmology. 2012; 119: 2312-2318 Abstract Full Text Full Text PDF PubMed Scopus (319) Google Scholar ). Three-year continuous intensive treatments and monitoring, a considerable challenge, produced only modest additional improvement. Early and Long-Term Responses to Anti–Vascular Endothelial Growth Factor Therapy in Diabetic Macular Edema: Analysis of Protocol I DataAmerican Journal of OphthalmologyVol. 172PreviewTo determine whether early visual acuity response to ranibizumab in diabetic macular edema is associated with long-term outcome. Full-Text PDF Open AccessReplyAmerican Journal of OphthalmologyVol. 177PreviewWe are pleased that Dr Ophir agrees with the importance of our retrospective analysis of pooled data from the DRCR.net Protocol I study1,2 and the need for the development of alternate approaches to diagnosis and treatment of diabetic macular edema (DME). In his letter, Dr Ophir re-emphasizes the modest gains received by many patients from intensive treatment and monitoring with ranibizumab plus prompt focal/grid laser treatment in the Protocol I study.2,3 In response to our statement that an effective treatment algorithm for DME is uncertain in this group of suboptimal responders, he offers a systematic evidence-based approach to diagnosis and treatment of diffuse diabetic macular edema (DDME) that relies on the choice of full-field 3D optical coherence tomography figures and video clips to accurately assess the most common tractional mechanisms of DDME, usually overlooked with the use of other imaging studies. Full-Text PDF