Ranibizumab Outcomes at 2 Years: Are They Holding Up?

Kapil G. Kapoor, MD; Sophie J. Bakri, MD


February 17, 2012

Expanded 2-Year Follow-Up of Ranibizumab Plus Prompt or Deferred Laser or Triamcinolone Plus Prompt Laser for Diabetic Macular Edema

Elman MJ, Bressler NM, Qin H, et al; Diabetic Retinopathy Clinical Research Network
Ophthalmology. 2011;118:609-614

Study Summary

This study is the most recent contribution by the Diabetic Retinopathy Clinical Research (DRCR) Network to our growing understanding of the safety and efficacy of therapeutic interventions for diabetic macular edema. In this study, patients were randomly assigned to receive:

  • Prompt laser and sham injection;

  • Prompt laser and 0.5 mg ranibizumab;

  • Deferred laser and 0.5 mg ranibizumab; or

  • Prompt laser and 4 mg triamcinolone.

The study is important because focal/grid photocoagulation has been the standard of care for diabetic macular edema since the Early Treatment Diabetic Retinopathy Study in 1985.[1]Elman and colleagues demonstrated superior efficacy of intravitreal ranibizumab (with prompt or deferred laser) over prompt laser alone, with a median of only 2-3 injections in the second year of the study. This study also demonstrated superior efficacy of triamcinolone with prompt laser over laser alone, but only in the subgroup of pseudophakic patients. The increased incidence of visually significant cataract and intraocular pressure spikes in patients treated with triamcinolone reinforces findings of previous studies.


The strengths of this study include a multicenter randomized clinical trial design, a large sample size (854 eyes of 691 participants), and 2-year follow-up. An important limitation is that these findings are applicable only to patients similar to the study cohort, which includes persons with diabetic macular edema involving the fovea with vision ranging from 20/32 to 20/320. Moreover, the findings may only be applicable if the DRCR retreatment algorithm is used.

In summary, this study upheld initial 1-year conclusions and further clarifies the role of intravitreal ranibizumab and triamcinolone treatment in diabetic macular edema. Further study will help to determine whether these treatment effects are sustained at 3 years.



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