Long-Term Effects of Anti-VEGF Therapy versus Panretinal Photocoagulation on Retinal Vessel Caliber in Eyes with Proliferative Diabetic Retinopathy

IF 5.7 Q1 OPHTHALMOLOGY

Ophthalmology. Retina Pub Date : 2025-10-01 DOI:10.1016/j.oret.2025.03.027

Steven Shen MD , Kristin Josic PhD , Jeong W. Pak PhD , Stacy M. Meuer BS , Michele Melia ScM , Amitha Domalpally MD, PhD , Jennifer K. Sun MD, MPH , Barbara Blodi MD , DRCR Retina Network

{"title":"Long-Term Effects of Anti-VEGF Therapy versus Panretinal Photocoagulation on Retinal Vessel Caliber in Eyes with Proliferative Diabetic Retinopathy","authors":"Steven Shen MD , Kristin Josic PhD , Jeong W. Pak PhD , Stacy M. Meuer BS , Michele Melia ScM , Amitha Domalpally MD, PhD , Jennifer K. Sun MD, MPH , Barbara Blodi MD , DRCR Retina Network","doi":"10.1016/j.oret.2025.03.027","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the long-term effects of ranibizumab<span><span><span> compared with panretinal photocoagulation (PRP) on retinal </span>vasculature in eyes with </span>proliferative diabetic retinopathy (PDR).</span></div></div><div><h3>Design</h3><div>Post hoc analysis<span> of DRCR Retina Network Protocol S randomized clinical trial.</span></div></div><div><h3>Participants</h3><div>Adults with type 1 or 2 diabetes and PDR in at least 1 eye.</div></div><div><h3>Methods</h3><div><span><span>Integrative Vessel Analysis software was used to measure central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) of vessels at 1 disc diameter from the optic nerve edge on fundus photographs at baseline, 2 and 5 years for study eyes randomized to </span>ranibizumab or PRP treatment for PDR. Changes in CRAE and CRVE were analyzed using mixed </span>linear regression models with multivariable adjustments.</div></div><div><h3>Main Outcome Measures</h3><div>Mean change in CRAE and CRVE from baseline to 2 and 5 years.</div></div><div><h3>Results</h3><div><span>Data from 107 eyes (90 participants) in the ranibizumab (n = 48) and PRP group (n = 59) were analyzed. For the ranibizumab versus PRP groups, CRAE decreased by a mean of 2 versus 12 μm at 2 years (mean difference, 10 μm; 95% confidence interval [CI], 4-16; </span><em>P</em> = 0.003); and 9 versus 13 μm at 5 years (mean difference, 4 μm; 95% CI, −2 to 10; <em>P</em> = 0.22). Central retinal venular equivalent decreased by 14 versus 19 μm at 2 years (mean difference, 4 μm; 95% CI, −3 to 11; <em>P</em> = 0.26) and 18 versus 28 μm at 5 years (mean difference, 11 μm; 95% CI, 3-19; <em>P</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>In patients with PDR, CRAE and CRVE decreased in both the ranibizumab and PRP groups at 5 years, but the rates of change before and after 2 years may be different. In this subset of eyes from Protocol S, the greater reduction in CRAE in the PRP group was statistically significant at 2 years but not at 5 years.</div><div>For CRVE, the PRP group decreased more than the ranibizumab group, but the difference was statistically significant at 5 but not 2 years. Future research may investigate the underlying causes for retinal arteriolar and venular narrowing after treatment for PDR, and the possibility of an anatomic correlation with visual field loss.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"9 10","pages":"Pages 964-971"},"PeriodicalIF":5.7000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ophthalmology. Retina","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2468653025001599","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

To evaluate the long-term effects of ranibizumab compared with panretinal photocoagulation (PRP) on retinal vasculature in eyes with proliferative diabetic retinopathy (PDR).

Design

Post hoc analysis of DRCR Retina Network Protocol S randomized clinical trial.

Participants

Adults with type 1 or 2 diabetes and PDR in at least 1 eye.

Methods

Integrative Vessel Analysis software was used to measure central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) of vessels at 1 disc diameter from the optic nerve edge on fundus photographs at baseline, 2 and 5 years for study eyes randomized to ranibizumab or PRP treatment for PDR. Changes in CRAE and CRVE were analyzed using mixed linear regression models with multivariable adjustments.

Main Outcome Measures

Mean change in CRAE and CRVE from baseline to 2 and 5 years.

Results

Data from 107 eyes (90 participants) in the ranibizumab (n = 48) and PRP group (n = 59) were analyzed. For the ranibizumab versus PRP groups, CRAE decreased by a mean of 2 versus 12 μm at 2 years (mean difference, 10 μm; 95% confidence interval [CI], 4-16; P = 0.003); and 9 versus 13 μm at 5 years (mean difference, 4 μm; 95% CI, −2 to 10; P = 0.22). Central retinal venular equivalent decreased by 14 versus 19 μm at 2 years (mean difference, 4 μm; 95% CI, −3 to 11; P = 0.26) and 18 versus 28 μm at 5 years (mean difference, 11 μm; 95% CI, 3-19; P = 0.01).

Conclusions

In patients with PDR, CRAE and CRVE decreased in both the ranibizumab and PRP groups at 5 years, but the rates of change before and after 2 years may be different. In this subset of eyes from Protocol S, the greater reduction in CRAE in the PRP group was statistically significant at 2 years but not at 5 years.

For CRVE, the PRP group decreased more than the ranibizumab group, but the difference was statistically significant at 5 but not 2 years. Future research may investigate the underlying causes for retinal arteriolar and venular narrowing after treatment for PDR, and the possibility of an anatomic correlation with visual field loss.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

查看原文本刊更多论文

抗vegf治疗与全视网膜光凝治疗对增殖性糖尿病视网膜病变视网膜血管直径的长期影响。

目的：比较雷尼单抗与全视网膜光凝治疗（PRP）对增殖性糖尿病视网膜病变（PDR）视网膜血管的长期影响。设计：DRCR视网膜网络协议S随机临床试验的事后分析。参与者：患有1型或2型糖尿病且至少一只眼睛有PDR的成年人。方法：使用综合血管分析软件测量眼底照片上视神经边缘1个椎间盘直径处血管的中央视网膜动脉当量（CRAE）和中央视网膜静脉当量（CRVE），基线，2年和5年随机分配到雷尼单抗或PRP治疗PDR的研究眼睛。采用多变量调整的混合线性回归模型分析cre和CRVE的变化。主要结局指标：cre和CRVE从基线到2年和5年的平均变化。结果：分析了雷尼单抗组（n = 48）和PRP组（n = 59） 107只眼睛（90名参与者）的数据。对于雷尼单抗组和PRP组，CRAE在2年后平均下降2 μm，而PRP组平均下降12 μm(平均差异为10 μm；95%置信区间[CI]， 4-16；P = 0.003)；5年9 μm vs 13 μm(平均差4 μm；95% CI, -2 ~ 10；P = 0.22)。2年后，中央视网膜静脉当量减少14 μm，而不是19 μm(平均差4 μm；95% CI, -3 ~ 11；P = 0.26)和18 vs 28 μm(平均差异为11 μm；95% ci, 3-19；P = 0.01)。结论：在PDR患者中，雷尼单抗组和PRP组在5年时CRAE和CRVE均有所下降，但2年前和2年后的变化率可能有所不同。在方案S的这组眼睛中，PRP组的cre在第2年有更大的降低，但在第5年没有统计学意义。对于CRVE， PRP组比雷尼单抗组下降更多，但差异在5年而不是2年具有统计学意义。未来的研究可能会探讨PDR治疗后视网膜小动脉和静脉狭窄的潜在原因，以及与视野丧失的解剖学相关性的可能性。财务披露：专有或商业披露可在本文末尾的脚注和披露中找到。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊