Is ranibizumab better than laser treatment for retinopathy?

This study compared the safety and effectiveness of ranibizumab (Lucentis) to panretinal photocoagulation (PRP) in adults with proliferative diabetic retinopathy (PDR). It was determined that both treatments improved visual acuity, and had similar rates of complications, but ranibizumab resulted in less visual field loss and lower rates of diabetic macular edema (DME).

PDR is a complication of diabetes that can cause blindness. In PDR blood vessels in the retina (part of the eye) become damaged, may start leaking blood and fluid, and increase in number and size, threatening vision. The main treatment for PDR since the 1970s is PRP. This treatment uses lasers to shrink the abnormal blood vessels that have formed in the retina. However, new treatments called anti-VEGF drugs, such as ranibizumab, have been developed. Ranibizumab acts by stopping the growth of new blood vessels into the retina. It is injected into the back of the eye (intravitreal administration). Ranibizumab has been shown to be effective for up to 2 years, but longer-term effects are still under investigation.

305 adults with PDR participated in this study. Both eyes of some participants were affected, so 394 eyes in total were treated. Eyes were randomly divided into two groups. Group 1 included 191 eyes and received ranibizumab injections every month for 24 weeks. Patients received further injections until PDR was resolved. The second group received PRP treatment at the start of the study and included 203 eyes. If PDR became worse after the first treatment, patients in Group 2 received further PRP. Both groups were followed up for 5 years. 

Both groups had similar improvements in visual acuity (the ability to see details). However, the visual field (total area that can be seen by the eyes) decreased in both groups. It decreased significantly more in the PRP group than the ranibizumab group, due to a loss of side (peripheral) vision. The ranibizumab group had a 60% lower risk of developing vision-impairing diabetic macular edema (DME; swelling in the back of the eye). Serious side effects such as stroke or myocardial infarction occurred at a similar rate in both groups.

The study concluded that, after 5 years, ranibizumab and PRP had similar results in improving visual acuity and a similar risk of side effects in adults with PDR. However, PRP resulted in more visual field loss and more DME.

Only 60% of participants who started the study completed all 5 years of the study.

This clinical trial was partly funded by Genentech, the manufacturer of ranibizumab.

Discuss the use of anti-VEGF drugs with your physician.