RODRIGO JORGE, MD, PHD RODRIGO S. OLIVEIRA, MD ANDRE MESSIAS, MD FELIPE P. ALMEIDA, MD MARIO L. STRAMBE, COT ROGÉRIO A. COSTA, MD, PHD Ribeirão Preto, Brazil INGRID U. SCOTT, MD, MPH Hershey, Pennsylvania
Proliferative diabetic retinopathy (PDR) is an important cause of severe vision loss in patients with diabetes mellitus. Laser photocoagulation is the standard treatment for retinal or optic disc neovascularization, and approximately 60% of patients respond to panretinal photocoagulation (PRP) with regression of neovascularization within 3 months. However, in some cases complete regression of neovascularization does not occur after PRP, but rather, persistent retinal neovascularization is present and approximately 4.5% of patients require pars plana vitrectomy despite PRP. Such cases, as well as the demonstrated upregulation of intravitreal vascular endothelial growth factor (VEGF) in patients with retinal neovascularization, have prompted investigations about anti-VEGF drugs for management of this condition. Based on the promising results using bevacizumab, we evaluated the effects of another humanized anti–VEGF-A neutralizing drug, intravitreal ranibizumab (IVR), in diabetic patients with persistent new vessels (NV) unresponsive to PRP performed at least 4 months prior, with best-corrected visual acuity (BCVA) of 20/32 or worse. Patients were not enrolled if they had a history of vitrectomy, thromboembolic event, sur- gery within the prior 6 months or planned within the next 28 days, uncontrolled hypertension, or known coagulation abnor- malities. If both eyes were eligible for treatment, the eye with worse visual acuity was included.
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