IMPORTANCE: Panretinal photocoagulation (PRP) is the standard treatment for reducing severe @entity227 from @entity6 . However, PRP can damage the retina, resulting in peripheral @entity1018 or worsening @entity1103 ( @entity1103 ). OBJECTIVE: To evaluate the noninferiority of intravitreous ranibizumab compared with PRP for visual acuity outcomes in @entity1 with @entity6 . DESIGN, SETTING, AND @entity1 : Randomized clinical trial conducted at 55 US sites among 305 adults with @entity6 enrolled between February and December 2012 (mean age, 52 years; 44% female; 52% white). Both eyes were enrolled for 89 @entity1 (1 eye to each study group), with a total of 394 study eyes. The final 2-year visit was completed in January 2015. INTERVENTIONS: Individual eyes were randomly assigned to receive PRP treatment, completed in 1 to 3 visits (n   =   203 eyes), or ranibizumab, 0.5 mg, by intravitreous injection at baseline and as frequently as every 4 weeks based on a structured re-treatment protocol (n   =   191 eyes). Eyes in both treatment groups could receive ranibizumab for @entity1103 . MAIN OUTCOMES AND MEASURES: The primary outcome was mean visual acuity change at 2 years (5-letter noninferiority margin; intention-to-treat analysis). Secondary outcomes included visual acuity area under the curve, peripheral @entity227 , vitrectomy, @entity1103 development, and @entity2479 . RESULTS: Mean visual acuity letter improvement at 2 years was +2.8 in the ranibizumab group vs +0.2 in the PRP group (difference, +2.2; 95% CI, -0.5 to +5.0; P   <   .001 for noninferiority). The mean treatment group difference in visual acuity area under the curve over 2 years was +4.2 (95% CI, +3.0 to +5.4; P   <   .001). Mean peripheral visual field sensitivity loss was worse (-23 dB vs -422 dB; difference, 372 dB; 95% CI, 213-531 dB; P   <   .001), vitrectomy was more frequent (15% vs 4%; difference, 9%; 95% CI, 4%-15%; P   <   .001), and @entity1103 development was more frequent (28% vs 9%; difference, 19%; 95% CI, 10%-28%; P   <   .001) in the PRP group vs the ranibizumab group, respectively. Eyes without active or regressed neovascularization at 2 years were not significantly different (35% in the ranibizumab group vs 30% in the PRP group; difference, 3%; 95% CI, -7% to 12%; P   =   .58). One eye in the ranibizumab group developed @entity3225 . No significant differences between groups in rates of major cardiovascular events were identified. CONCLUSIONS AND RELEVANCE: Among eyes with @entity6 , treatment with ranibizumab resulted in visual acuity that was noninferior to (not worse than) PRP treatment at 2 years. Although longer-term follow-up is needed, ranibizumab may be a reasonable treatment alternative, at least through 2 years, for @entity1 with @entity6 . TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01489189.

Panretinal Photocoagulation vs Intravitreous Ranibizumab for Proliferative XXXX : A Randomized Clinical Trial.

@entity1018 :: ('MESH:D054062', 'Disease') :: ['vision loss'] @entity1 :: ('9606', 'Species') :: ['participants', 'patients', 'PARTICIPANTS'] @entity227 :: ('MESH:D014786', 'Disease') :: ['visual loss', 'visual field loss'] @entity6 :: ('MESH:D003920', 'Disease') :: ['proliferative diabetic retinopathy'] @entity2479 :: ('MESH:D012173', 'Disease') :: ['retinal neovascularization'] @entity1103 :: ('MESH:D008269', 'Disease') :: ['DME', 'diabetic macular edema'] @entity3225 :: ('MESH:D009877', 'Disease') :: ['endophthalmitis']
@entity6 :: (MESH:D003920,Disease) :: ['Diabetic Retinopathy']
