RANDOMIZEDTRIAL EVALUATING SHORT-TERM EFFECTS OF INTRAVITREAL RANIBIZUMAB OR TRIAMCINOLONE ACETONIDE ON MACULAR EDEMA AFTER FOCAL/GRID LASER FOR DIABETIC MACULAR EDEMA IN EYES ALSO RECEIVING PANRETINAL PHOTOCOAGULATION

作者：Googe Joseph^*; Brucker Alexander J; Bressler Neil M; Qin Haijing; Aiello Lloyd P; Antoszyk Andrew; Beck Roy W; Bressler Susan B; Ferris Frederick L III; Glassman Adam R; Marcus Dennis; Stockdale Cynthia R

来源：Retina-The Journal of Retinal and Vitreous Diseases, 2011, 31(6): 1009-1027.

DOI：10.1097/IAE.0b013e318217d739

• proliferative diabetic retinopathy
• diabetic macular edema
• panretinal photocoagulation
• ranibizumab
• triamcinolone
• randomized clinical trial
• Diabetic Retinopathy Clinical Research Network

Purpose: To evaluate 14-week effects of intravitreal ranibizumab or triamcinolone in eyes receiving focal/grid laser for diabetic macular edema and panretinal photocoagulation.
Methods: Three hundred and forty-five eyes with a visual acuity of 20/320 or better, center-involved diabetic macular edema receiving focal/grid laser, and diabetic retinopathy receiving prompt panretinal photocoagulation were randomly assigned to sham (n = 123), 0.5-mg ranibizumab (n = 113) at baseline and 4 weeks, and 4-mg triamcinolone at baseline and sham at 4 weeks (n = 109). Treatment was at investigator discretion from 14 weeks to 56 weeks.
Results: Mean changes (+/-SD) in visual acuity letter score from baseline were significantly better in the ranibizumab (+1 +/- 11; P < 0.001) and triamcinolone (+2 +/- 11; P, 0.001) groups compared with those in the sham group (24 +/- 14) at the 14-week visit, mirroring retinal thickening results. These differences were not maintained when study participants were followed for 56 weeks for safety outcomes. One eye (0.9%; 95% confidence interval, 0.02%-4.7%) developed endophthalmitis after receiving ranibizumab. Cerebrovascular/cardiovascular events occurred in 4%, 7%, and 3% of the sham, ranibizumab, and triamcinolone groups, respectively.
Conclusion: The addition of 1 intravitreal triamcinolone injection or 2 intravitreal ranibizumab injections in eyes receiving focal/grid laser for diabetic macular edema and panretinal photocoagulation is associated with better visual acuity and decreased macular edema by 14 weeks. Whether continued long-term intravitreal treatment is beneficial cannot be determined from this study. RETINA 31: 1009-1027, 2011

• 出版日期2011-6