SECTION EDITOR: ANNE S. LINDBLAD, PhD
Author Affiliations: Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Group Information: The members of the READ-2 Study Group are listed at the end of this article.
Objective To assess the benefit of increased follow-up and treatment with ranibizumab between months 24 and 36 in the Ranibizumab for Edema of the Macula in Diabetes (READ-2) Study.
Design Prospective, interventional, multicenter follow-up of a randomized clinical trial.
Methods Patients who agreed to participate between months 24 and 36 (ranibizumab, 28 patients; laser, 22; and ranibizumab + laser, 24) returned monthly and received ranibizumab, 0.5 mg, if foveal thickness (FTH, center subfield thickness) was 250 μm or greater. Main outcome measures were improvement in best-corrected visual acuity (BCVA) and reduction in FTH between months 24 and 36.
Results Mean improvement from the baseline BCVA in the ranibizumab group was 10.3 letters at month 36 vs 7.2 letters at month 24 (ΔBCVA letters = 3.1, P = .009), and FTH at month 36 was 282 μm vs 352 μm at month 24 (ΔFTH = 70 μm, P = .006). Changes in BCVA and FTH in the laser group (−1.6 letters and −36 μm, respectively) and the ranibizumab + laser group (+2.0 letters and −24 μm) were not statistically significant. The mean number of ranibizumab injections was significantly greater in the ranibizumab group compared with the laser group (5.4 vs 2.3 injections, P = .008) but not compared with the ranibizumab + laser group (3.3, P = .11).
Conclusions More aggressive treatment with ranibizumab during year 3 resulted in a reduction in mean FTH and improvement in BCVA in the ranibizumab group. More extensive focal/grid laser therapy in the other 2 groups may have reduced the need for more frequent ranibizumab injections to control edema.
Application to Clinical Practice Long-term visual outcomes for treatment of diabetic macular edema with ranibizumab are excellent, but many patients require frequent injections to optimally control edema and maximize vision.
Trial Registration clinicaltrials.gov Identifier:NCT00407381
Do DV, Nguyen QD, Khwaja AA, Channa R, Sepah YJ, Sophie R, Hafiz G, Campochiaro PA, READ-2 Study Group FT. Ranibizumab for Edema of the Macula in Diabetes Study3-Year Outcomes and the Need for Prolonged Frequent Treatment. JAMA Ophthalmol. 2013;131(2):139-145. doi:10.1001/2013.jamaophthalmol.91