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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article provides an update on some key trials conducted by the Diabetic Retinopathy Clinical Research Network (\u003Ca href=\u0022http:\/\/DRCR.net\u0022\u003EDRCR.net\u003C\/a\u003E), including important contributions from Protocol I. This study showed that anti-vascular endothelial growth factor (VEGF) therapy as an initial strategy should be the gold standard of treatment for diabetic macular edema.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERetinal Diseases Diabetes Mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERetinal Diseases\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEndocrinology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Metabolic Syndrome\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn a symposium addressing current efforts to manage diabetic retinopathy, Lee M. Jampol, MD, Northwestern University, Chicago, Illinois, USA, provided an update on some key trials conducted by the Diabetic Retinopathy Clinical Research Network (\u003Ca href=\u0022http:\/\/DRCR.net\u0022\u003EDRCR.net\u003C\/a\u003E), including important contributions from Protocol I. This study showed that anti-vascular endothelial growth factor (VEGF) therapy as an initial strategy should be the gold standard of treatment for diabetic macular edema (DME).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EFor decades, focal laser photocoagulation was the standard of care, and was highly effective, for treatment of DME. However, this technique is time-consuming and is sometimes associated with loss of central vision. In recent times, anti-VEGF agents have revolutionized the management of these conditions by targeting VEGF, an angiogenic mitogen with a pivotal role in the pathogenesis of DME.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EOne of the most important studies from \u003Ca href=\u0022http:\/\/DRCR.net\u0022\u003EDRCR.net\u003C\/a\u003E is Protocol I, a randomized, controlled trial, which evaluated the efficacy of\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n            \u003Cp id=\u0022p-5\u0022\u003Eintravitreal ranibizumab 0.5 mg in combination with prompt or deferred (after 6 months) laser photocoagulation,\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n            \u003Cp id=\u0022p-6\u0022\u003Eprompt focal\/grid laser treatment alone for treatment of central involvement DME, and\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n            \u003Cp id=\u0022p-7\u0022\u003Eintravitreal triamcinolone acetonide 4 mg with prompt laser treatment.\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-8\u0022\u003EIn total, 691 patients (854 eyes) with central-involvement DME were enrolled.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EAfter 1 year, eyes treated with intravitreal ranibizumab and prompt or deferred laser had better visual acuity (VA) letter scores compared with focal laser with sham injection. The mean change in VA from baseline was significantly greater in the ranibizumab plus prompt laser group (p\u0026lt; .001) and ranibizumab plus deferred laser group (p\u0026lt; .001), but not in the triamcinolone plus prompt laser group (p = .31; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/23\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Mean Change in Visual Acuity\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-366676463\u0022 data-figure-caption=\u0022Mean Change in Visual Acuity\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/23\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/23\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/23\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14657\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EMean Change in Visual Acuity\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003Ep values for difference in mean change in visual acuity from sham+prompt laser at the 52-week visit: ranibizumab+prompt laser \u0026lt; .001; ranibizumab+deferred laser \u0026lt; .001; and triamcinolone+prompt laser = .31.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Diabetic Retinopathy Clinical Research Network. Randomized Trial Evaluating Ranibizumab Plus Prompt or Deferred Laser or Triamcinolone Plus Prompt Laser for Diabetic Macular Edema. \u003Cem\u003EOphthalmology\u003C\/em\u003E 2010; 117(6):1064\u20131077. With permission from Elsevier.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003E*On November 21, 2014, this was changed from Sharm to Sham.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EVisual acuity benefit often cannot be maintained in neovascular age-related macular degeneration if the frequency of ranibizumab injection is decreased from a monthly injection protocol. However, Protocol I demonstrated benefit with the use of anti-VEGF therapy for DME. Data showed that improved VA was maintained in these patients for more than 3 years of follow-up despite a decreasing number of intravitreal injections of ranibizumab: a median of 6 injections for the first 6 months, 3 injections in the second 6 months, 2 to 3 injections in the second year, and 1 to 2 injections in the third year [Diabetic Retinopathy Clinical Research Network \u003Cem\u003EOphthalmology\u003C\/em\u003E 2012; 2010].\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EAdditional \u003Ca href=\u0022http:\/\/DRCR.net\u0022\u003EDRCR.net\u003C\/a\u003E research in this field is underway. Protocol S and Protocol T are near completion. The noninferiority Protocol S study is comparing 2-year VA outcomes in patients with proliferative diabetic retinopathy treated with anti-VEGF therapy plus deferred panretinal photocoagulation (PRP) or standard, prompt PRP therapy. Protocol T is a comparative effectiveness study of three intravitreal anti-VEGF agents\u2014aflibercept, bevacizumab, and ranibizumab\u2014in patients with DME. The primary outcome is mean change in VA.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/19\/23.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp2xd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp2xd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}