Artikel
Vergleich von Ranibizumab kombiniert mit navigierter Laserphotokoagulation vs. Ranibizumab Monotherapie beim Diabetischen Makulaödem – 3-Jahres-Daten
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Autoren
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T. Herold
- Augenklinik der LMU München
| Veröffentlicht: | 9. Dezember 2016 |
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Gliederung
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Purpose: Theprospective CAVNAV study previously showed that a combination of navigated laser photocoagulation (Navilas) and intravitreal injections with ranibizumab achieved similar visual gains at year 1 compared to ranibizumab monotherapy with a significantlyreduced number of injections.
The purpose of this study was to determine if the long-term stability of visual gains and lower need of injections in combination therapy patients stated at year 1 could be maintained in a 3 year-follow-up period.
Setting: Retrospective analysis of patients of the CAVNAV study in the long term follow-up from month 12 to 36
Methods: The charts of CAVNAV patients in both armsremaining under the care of the investigators were subjected to retrospective analysis to determine BCVA at 12, 24 and 36 months and injection count from months 13-36. BCVA measurements following the original 1 year study were taken using logMAR charts. Injections had beenprovided with standard of care using PRN based on change in BCVA and CRT using Spectral domain OCT scans.
Main outcome measures was change in BCVA and mean number of injections from baseline (12 months) to month 36.
Results: BCVA was stable within one line of vision in both groups between from 12 through 36 months, with both cohorts showing a change of 0.16 ±0.1 logMAR. The lead in BCVA of the cohort with navigated laser of approximately 2 lines was also maintained through month 36.
Following the initial reduction in required injections at month 12, combination therapy patients continued to require 1.4 times fewer injections over the next 24 months (2.91 ± 2.3 vs 4.27 ±3.8 injections for monotherapy).
Conclusion: Combination of navigated laser and ranibizumab achieved BCVA gains comparable to anti-VEGF monotherapy. These results could be maintained through month 36.
Concerning the number of required ranibizumab injections we observed a reduction of 3 injections in year 1 and further 1.4 injections in year 2 and 3 compared to the monotherapy group. Thus, adding navigated laser photocoagulation to intravitreal anti-VEGF therapy may represent a superior therapeutic approach to DME patients with stable functional results and lower injection burden.
