Nguyen Quan Dong, Shah Syed Mahmood, Heier Jeffery S, Do Diana V, Lim Jennifer, Boyer David, Abraham Prema, Campochiaro Peter A
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-9277, USA.
Ophthalmology. 2009 Nov;116(11):2175-81.e1. doi: 10.1016/j.ophtha.2009.04.023. Epub 2009 Aug 22.
To compare ranibizumab with focal/grid laser or a combination of both in diabetic macular edema (DME).
Prospective, randomized, interventional, multicenter clinical trial.
A total of 126 patients with DME.
Subjects were randomized 1:1:1 to receive 0.5 mg of ranibizumab at baseline and months 1, 3, and 5 (group 1, 42 patients), focal/grid laser photocoagulation at baseline and month 3 if needed (group 2, 42 patients), or a combination of 0.5 mg of ranibizumab and focal/grid laser at baseline and month 3 (group 3, 42 patients).
The primary end point was the change from baseline in best-corrected visual acuity (BCVA) at month 6.
At month 6, the mean gain in BCVA was significantly greater in group 1 (+7.24 letters, P = 0.01, analysis of variance) compared with group 2 (-0.43 letters), and group 3 (+3.80 letters) was not statistically different from groups 1 or 2. For patients with data available at 6 months, improvement of 3 lines or more occurred in 8 of 37 (22%) in group 1 compared with 0 of 38 (0%) in group 2 (P = 0.002, Fisher exact test) and 3 of 40 (8%) in group 3. Excess foveal thickness was reduced by 50%, 33%, and 45% in groups 1, 2, and 3, respectively.
During a span of 6 months, ranibizumab injections by the current protocol had a significantly better visual outcome than focal/grid laser treatment in patients with DME.
比较雷珠单抗与局部/格栅样激光或两者联合应用于糖尿病性黄斑水肿(DME)的疗效。
前瞻性、随机、干预性、多中心临床试验。
共126例DME患者。
受试者按1:1:1随机分组,分别在基线期、第1、3和5个月接受0.5mg雷珠单抗治疗(第1组,42例患者);在基线期及必要时于第3个月接受局部/格栅样激光光凝治疗(第2组,42例患者);或在基线期及第3个月接受0.5mg雷珠单抗与局部/格栅样激光联合治疗(第3组,42例患者)。
主要终点为第6个月时最佳矫正视力(BCVA)相对于基线的变化。
第6个月时,第1组BCVA的平均提高幅度(+7.24字母,P = 0.01,方差分析)显著大于第2组(-0.43字母),第3组(+3.80字母)与第1组或第2组相比无统计学差异。对于6个月时有可用数据的患者,第1组37例中有8例(22%)视力提高3行或更多,而第2组38例中无1例(0%)(P = 0.002,Fisher精确检验),第3组40例中有3例(8%)。第1、2和3组中心凹厚度分别减少了50%、33%和45%。
在6个月的观察期内,按照当前方案注射雷珠单抗在DME患者中的视力改善效果显著优于局部/格栅样激光治疗。