title: Ranibizumab for edema of the macula in diabetes study: 3-year outcomes and the need for prolonged frequent treatment.
abstract: OBJECTIVE
  To assess the benefit of increased follow-up and treatment with ranibizumab between months 24 and 36 in the Ranibizumab for Edema of the Macula in Diabetes (READ-2) Study.
  
  
  METHODS
  Prospective, interventional, multicenter follow-up of a randomized clinical trial.
  
  
  METHODS
  Patients who agreed to participate between months 24 and 36 (ranibizumab, 28 patients; laser, 22; and ranibizumab + laser, 24) returned monthly and received ranibizumab, 0.5 mg, if foveal thickness (FTH, center subfield thickness) was 250 μm or greater. Main outcome measures were improvement in best-corrected visual acuity (BCVA) and reduction in FTH between months 24 and 36.
  
  
  RESULTS
  Mean improvement from the baseline BCVA in the ranibizumab group was 10.3 letters at month 36 vs 7.2 letters at month 24 (ΔBCVA letters = 3.1, P = .009), and FTH at month 36 was 282 μm vs 352 μm at month 24 (ΔFTH = 70 μm, P = .006). Changes in BCVA and FTH in the laser group (-1.6 letters and -36 μm, respectively) and the ranibizumab + laser group (+2.0 letters and -24 μm) were not statistically significant. The mean number of ranibizumab injections was significantly greater in the ranibizumab group compared with the laser group (5.4 vs 2.3 injections, P = .008) but not compared with the ranibizumab + laser group (3.3, P = .11).
  
  
  CONCLUSIONS
  More aggressive treatment with ranibizumab during year 3 resulted in a reduction in mean FTH and improvement in BCVA in the ranibizumab group. More extensive focal/grid laser therapy in the other 2 groups may have reduced the need for more frequent ranibizumab injections to control edema.
  
  
  CONCLUSIONS
  Long-term visual outcomes for treatment of diabetic macular edema with ranibizumab are excellent, but many patients require frequent injections to optimally control edema and maximize vision.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier:NCT00407381
authors.affiliation: Wilmer Eye Institute, The Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA.
authors.forename: Diana V
authors.initials: DV
authors.lastname: Do
authors.forename: Quan D
authors.initials: QD
authors.lastname: Nguyen
authors.forename: Afsheen A
authors.initials: AA
authors.lastname: Khwaja
authors.forename: Roomasa
authors.initials: R
authors.lastname: Channa
authors.forename: Yasir J
authors.initials: YJ
authors.lastname: Sepah
authors.forename: Raafay
authors.initials: R
authors.lastname: Sophie
authors.forename: Gulnar
authors.initials: G
authors.lastname: Hafiz
authors.forename: Peter A
authors.initials: PA
authors.lastname: Campochiaro
mesh_terms: D000293:Adolescent; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005584:Fovea Centralis / Q000473:pathology; D006801:Humans; D058449:Intravitreal Injections; D017075:Laser Coagulation; D008269:Macular Edema / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D000069579:Ranibizumab; D019233:Retreatment; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab