![]() 10 The Diabetic Retinopathy Clinical Research Network (DRCRnet) Protocol S study was the first study to show that monthly ranibizumab injections for at least 3 months followed by aggressive retreatment of recurrent or reactivated retinal neovascularization over 2 years resulted in noninferior visual outcomes compared with PRP with less need for vitrectomy and lower prevalence of diabetic macular edema. 12, 13 There are several clinical studies that have shown that short-term anti-VEGF therapy cause regression of new vessels in patients with PDR with reactivation of new vessels once anti-VEGF treatment is withdrawn. A more recently introduced anti-VEGF agent is aflibercept, which blocks VEGF A, VEGF B, placental growth factor (PIGF), and Galectin-1. Bevacizumab and ranibizumab are humanized monoclonal antibodies that specifically bind to all isomers of VEGF-A, with ranibizumab being a Fab antibody fragment compared with a whole antibody, bevacizumab. There were no significant differences in global change in intravascular oxygen saturation or areas of retinal nonperfusion between the two groups by 52 weeks.Ĭurrently, there are three anti-VEGF agents used in clinical practice. Intravitreal aflibercept achieved an earlier and complete regression of neovascularization in proliferative diabetic retinopathy compared with PRP. At week 52, this measured 0.24 DA in the PRP group and 0 DA in the aflibercept group ( P = 0.45). The median baseline area of neovascularization decreased from 0.98 DA to 0.68 DA in the PRP group and from 0.70 DA to 0 DA in the aflibercept group at week 12 ( P = 0.019). The baseline mean area of retinal nonperfusion of 125.1 DA and 131.2 DA in the PRP and aflibercept groups increased to 156.1 DA and 158.4 DA, respectively, at week 52 ( P = 0.46). The difference in AVD between groups at week 52 was 4.0% (95% confidence interval, −0.08, 8.8 P = 0.10). ![]() The AVD in the PRP group increased from 36.7% at baseline to 39.7%, whereas it decreased from 33.4% to 32.5% in the aflibercept group. The outcomes were retinal arterio-venous oximetry differences (AVD), area of retinal nonperfusion, and area of neovascularization in disc areas (DA). Ultra-widefield color fundus imaging was performed at baseline, week 12, and week 52. Retinal oximetry and ultra-widefield angiography were performed at baseline and week 52. Forty patients with proliferative diabetic retinopathy were randomized to PRP or intravitreal aflibercept treatment for 52 weeks. This is a prospective randomized single center study. The purpose of this study was to study the effects of panretinal photocoagulation (PRP) and intravitreal aflibercept on retinal vessel oxygen saturations, area of retinal nonperfusion, and area of neovascularization in proliferative diabetic retinopathy.
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