Exploratory analysis of the effect of intravitreal ranibizumab or triamcinolone on worsening of diabetic retinopathy in a randomized clinical trial.

Abstract

Diabetic retinopathy is characterized, in part, by development and worsening of retinal ischemia. The anatomic sequel of this pathophysiologic process, retinal neovascularization or proliferative diabetic retinopathy (PDR), can lead to vitreous hemorrhage, traction detachment from fibrous proliferation, or neovascular glaucoma. Irreversible vision loss can result from complications of PDR, although the frequency of severe vision loss is markedly reduced if panretinal photocoagulation (PRP) is performed. In the Early Treatment Diabetic Retinopathy Study (ETDRS),¹ approximately 70% of participants with moderately severe to severe nonproliferative diabetic retinopathy at baseline progressed to PDR within 5 years when the participants were assigned to deferral of photocoagulation (ie, initiation of PRP only if high-risk proliferative retinopathy developed). In another study by the Diabetic Retinopathy Study Group,² nearly half the eyes in which PDR developed experienced profound visual acuity loss (Snellen visual acuity worse than 5/200) from vitreous hemorrhage or traction retinal detachment by 5 years.