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Comparative Evaluation of Pan Anti-VEGF with Selective Anti-VEGF with Laser for Diabetic Macular Edema in Indian Eyes: A Randomized Prospective Study

Kumar Atul, Majumdar Saptorshi, Azad RV, Sharma Yog Raj, Chandra Parijat and Sinha Subijay

Background: To evaluate intravitreal 0.5 mg ranibizumab plus laser with 0.3 mg pegaptanib plus laser with focal/ grid laser alone for treatment of diabetic macular edema (DME)
Methods: A total of 45 study eyes with DME involving the fovea and visual acuity (VA) of 20/32 or worse were randomized into three groups, ranibizumab 0.5 mg + prompt laser (Group 1), pegaptanib sodium 0.3 mg + prompt laser (Group 2) and laser alone (Group 3) with 15 eyes in each study arm. Retreatment was based on optical coherence tomography measurements and VA changes.
Results: The mean VA change (± standard deviation) at 1 year in Groups 1, 2 and 3 were 10.4±2.1, 7.6±2.3 and 2±2.7 letters (p<0.001) respectively on a standardized ETDRS chart. There was no significant difference between the VA gain between Group 1 and 2 at 1 year (p=0.189) however significant difference existed between Groups 1 and 2 when compared to Group 3 (p=0.0001).
Conclusions: Ranibizumab and Pegaptanib with prompt focal/grid laser proved to be more effective than prompt focal/grid laser alone in treatment of center involved DME. There was no statistical difference in the visual gain achieved in the two intravitreal groups.