Delayed or immediate laser treatment for DME yield similar results

San Diego-According to research recently presented at the American Society of Retina Specialists annual meeting, focal or grid laser treatment that coincides with the initiation of intravitreal ranibizumab for the treatment of diabetic macular edema (DME) shows results no better than when laser treatment is deferred for 24 weeks or more.

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But John Wells, MD, said deferral may require more injections over five years to achieve results comparable to those of the study.

Some previous reports have suggested that intravitreal ranibizumab in combination with either prompt or deferred laser treatment is more effective than laser treatment alone. A three-year comparison of ranibizumab groups showed that prompt laser use is no better than deferred laser use, and is possibly worse.

Researchers conducted a multicenter prospective randomized clinical trial of patients with DME and vision impairment, and followed them for five years. All the eyes were treated with ranibizumab 0.5 mg every four weeks until either the eye was no longer improving or until the investigator decided to stop. Eyes were randomly assigned to either prompt or deferred laser treatment. The deferred group received laser treatment at least 24 weeks after the initiation of ranibizumab, and only if the DME was not improving.

After five years, patients in the deferred group gained 2.6 more letters of visual acuity than those in the prompt group, however, the difference was not statistically significant. But 38 percent of patients in the deferred group gained more than 15 letters, compared to 27 percent in the prompt group. In addition, 56 patients in the deferred group were able to do refrain from laser treatment altogether.

There was no difference in safety between the two groups, although patients in the deferred group needed a median of four injections more than those in the prompt group.