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Jang won Heo, Jeong Hee Lee, Yasir J. Sepah, R Channa, Morgan Renner, Ahmed S. Fahmy, A Khwaja, Zubir Rentiya, Q D. Nguyen, D V. Do; Evaluation of Fluorescein Angiograms in Eyes with Diabetic Macular Edema Treated with Ranibizumab over a 24-Month Period. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5330.
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To evaluate the changes in macular vasculature of eyes with diabetic macular edema (DME) treated with ranibizumab (RBZ).
Fluorescein angiograms (FA) from patients in the Ranibizumab for Edema of the mAcula in Diabetes (READ-2 Study), a prospective randomized clinical trial, was systematically analyzed in the Reading Center (RIRRC) by 3 independent graders. The area graded was comprised of a 6-mm circular grid centered on the fovea. In the READ-2 study, 126 patients with DME were randomized (1:1:1) to receive 0.5 mg of RBZ (group 1), focal/grid laser photocoagulation (group 2), or a combination of RBZ and focal/grid laser (group 3). After month 6, the majority of subjects received monotherapy with RBZ. FA at baseline (BL) and month 24 were analyzed for 39 randomly selected subjects (13 eyes from each of groups 1, 2, and 3). Three variables were evaluated: areas of capillary non-perfusion, source and types [microaneurysms (MA) or diffuse] of leakage, and number of MAs contributing to leakage.
At month 24, the area of capillary non-perfusion did not change in any group when compared with BL. There was no change in the pattern of leakage in 83%, 55.6%, and 45.5% of eyes in groups 1, 2, and 3, respectively. The average number of leaking MAs decreased by 15.6% (group 1), 21.6% (group 2), and 9.2% (group 3). There was no statistically significant difference among the three groups in their longitudinal changes (BL to M24) based on the three defined variables (p=0.657, 0.332, 0.304).
Analyses showed that vascular endothelial growth factor (VEGF) inhibition over 24 months with RBZ in eyes with DME did not result in increased capillary non-perfusion within the macula. In addition, RBZ injections appeared to decrease the number of leaking MAs. Further studies are needed in a larger study population to determine the effects of chronic VEGF suppression in eyes with DME.
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