Figure 2.

Effect of anti-VEGF therapy on vision and retinal thickening. The DRCR.net has published the 1-year results of a phase III trial that evaluated the safety and efficacy of intravitreal 0.5-mg ranibizumab or 4-mg triamcinolone treatments combined with focal/grid laser compared with focal/grid laser alone for the treatment of DME (Elman et al. 2010). Patients were randomized into four treatment arms: 0.5 mg intravitreal ranibizumab with prompt laser treatment (n = 187); 0.5 mg intravitreal ranibizumab with laser treatment deferred for at least 24 weeks (n = 188); focal/grid laser alone with sham injection (n = 293); and 4 mg intravitreal triamcinolone with prompt laser treatment (n = 186). (A) At 1 year, the mean change in the visual acuity letter score from baseline was significantly greater in the ranibizumab with prompt laser group (+9, P = 0.001) and ranibizumab with deferred laser group (+9, P = 0.001), but not in the triamcinolone with prompt laser group (+4, P = 0.31) compared with the sham injections with prompt laser group (+3). (B) Anti-VEGF treatment causes more favorable reductions in retinal thickness than laser alone, an effect that parallels the overall visual acuity results in the treatment groups. (Figure derived from Elman et al. 2010; reprinted, with permission, from the author.)