The Diabetic Retinopathy Clinical Research (DRCR) Network trials continue to churn out clinically relevant findings to help guide therapy for patients with diabetic retinopathy (DR).

A review in the May Current Opinion in Ophthalmology reveals eyes with diabetic macular edema (DME) and visual acuity (VA) of 20/50 or worse had more improvement in VA over a two-year span with aflibercept treatment compared with those that had bevacizumab or ranibizumab therapy. Aflibercept also showed higher rates of improvements in DR severity among eyes with proliferative DR (PDR) and vision-impairing DME at baseline compared with the other two drugs.

For eyes with PDR, ranibizumab may be a more effective therapy than laser procedures, however, as results show lower rates of PDR-worsening events compared with panretinal photocoagulation.

For eyes with PDR, ranibizumab was associated with lower rates of developing PDR-worsening events compared with panretinal photocoagulation, especially among eyes that did not receive ranibizumab for central-involved DME at baseline. Ranibizumab is cost-effective for PDR for eyes with, not without, vision-impairing central-involved DME, highlighting challenges when safety and efficacy results are at odds with cost-effectiveness results.

The researchers also looked into the efficacy of intravitreous corticosteroids post anti-vascular endothelial growth factor (VEGF) injections and found no VA improvement between eyes that received intravitreous corticosteroids and those that received a sham injection.

The next steps for the DRCR Network trials include “determining the role of intravitreous anti-VEGF therapy in treating eyes with DME and very good visual acuity, severe nonproliferative diabetic retinopathy, or vitreous hemorrhage, as well as trials involving other major public health problems in retinal diseases, such as age-related macular degeneration,” the report concludes.

Krick TW, Bressler NM. Recent clinically relevant highlights from the Diabetic Retinopathy Clinical Research Network. Curr Opin Ophthalmol. 2018;29(3):199-205.