A combination of intravitreal injection of Lucentis (ranibizumab) plus laser has just been proven to be a new and more effective treatment for diabetic macular edema. For the past 25 years, laser photocoagulation (aka laser treatment) has been the mainstay for this most common complication of diabetic retinopathy.
The new treatment involves Lucentis, the anti-VEGF drug also used to treat macular degeneration, in combination with laser photocoagulation. When used together, a significant improvement is noted.
Traditionally, patients with diabetic macular edema (DME) were treated with laser treatment. This was pretty successful in keeping patient’s vision stable, yet only a minority of patients did improve.
Over the past two years, there have been many “studies” reporting the use of intravitreal injections of Avastin, Lucentis or steroids as a successful method to treat DME. This study is noteworthy for the large number of patient that were improved and by the amount of improvement. Over half the patients experienced vision improvement with the Lucentis plus laser group compared to 28% in the traditional (laser only) treatment.
The significance of the new study was the determination that laser treatment, when given shortly after injection, yielded the best results.
Other combinations were compared; injection with Lucentis and delayed laser as well as triamcinolone (Triesence, a steroid used for injection). Again, the best combination was determined when laser was applied within 3-10 days following the intraocular injection.
During the course of the 24 month study, the injections were repeated as often as monthly. The visual improvement was sustained over the study period. 3 year results are anticipated.
What Does This Mean? This may quickly become the standard to treat diabetic macular edema. The results, actually of all 3 arms, were improved compared to just laser treatment alone. This may become easily integrated as there really is no new technology introduced to the treatment, but simply combining two regimens already commonly used in the office.
There are small risks with the injections. Intraocular infection is the most feared.
Avastin, an anti-VEGF drug also manufactured by Genetech, will probably be quickly tested, too. It is already used by many of us (retina specialists, that is) for the treatment of wet macular degeneration due to its clinical usefulness and cost (it is much, much cheaper than Lucentis).
Still to be determined is whether this new regimen, Lucentis plus laser, will be endorsed by the insurance companies. Until then, the patient will be responsible for the $2000 cost of the injection. I wouldn’t be surprised if many patients choose Avastin as they have with macular degeneration.