Vascular Endothelial Growth Factor Is a Critical Stimulus for Diabetic Macular Edema

• Published in: American journal of ophthalmology 2006-12, Vol.142 (6), p.961-969.e4
• Main Authors: Nguyen, Quan Dong, Tatlipinar, Sinan, Shah, Syed Mahmood, Haller, Julia A., Quinlan, Edward, Sung, Jennifer, Zimmer-Galler, Ingrid, Do, Diana V., Campochiaro, Peter A.
• Format: Article
• Language: English
• Subjects: Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Humanized; Biological and medical sciences; Chronic Disease; Diabetes; Diabetes. Impaired glucose tolerance; Diabetic retinopathy; Diabetic Retinopathy - diagnosis; Diabetic Retinopathy - drug therapy; Diabetic Retinopathy - metabolism; Drug dosages; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Fovea Centralis - drug effects; Fovea Centralis - pathology; Humans; Hypoxia; Injections; Lasers; Macular degeneration; Macular Edema - diagnosis; Macular Edema - drug therapy; Macular Edema - metabolism; Male; Medical imaging; Medical sciences; Middle Aged; Miscellaneous; Ophthalmology; Permeability; Ranibizumab; Tomography, Optical Coherence; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Vascular Endothelial Growth Factor A - physiology; Visual Acuity - drug effects; Visual Acuity - physiology; Vitreous Body
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2006.06.068

The role of vascular endothelial growth factor (VEGF) in diabetic macular edema (DME) was tested with ranibizumab, a specific antagonist of VEGF. A nonrandomized clinical trial. Ten patients with chronic DME received intraocular injections of 0.5 mg of ranibizumab at baseline and at one, two, four, and six months. The primary outcome was change in foveal thickness between baseline and seven months, and the secondary outcome measures were changes from baseline in visual acuity and macular volume. Mean values at baseline were 503 μm for foveal thickness, 9.22 mm 3 for macular volume, and 28.1 letters (20/80) read on an Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart. At seven months (one month after the fifth injection), the mean foveal thickness was 257 μm, which was a reduction of 246 μm (85% of the excess foveal thickness present at baseline; P = .005 by Wilcoxon signed-rank test for likelihood that this change is due to ranibizumab rather than chance). The macular volume was 7.47 mm 3, which was a reduction of 1.75 mm 3 (77% of the excess macular volume at baseline; P = .009). Mean visual acuity was 40.4 letters (20/40), which was an improvement of 12.3 letters ( P = .005). The injections were well-tolerated with no ocular or systemic adverse events. Intraocular injections of ranibizumab significantly reduced foveal thickness and improved visual acuity in 10 patients with DME, which demonstrated that VEGF is an important therapeutic target for DME. A randomized, controlled, double-masked trial is needed to test whether intraocular injections of ranibizumab provide long-term benefit to patients with DME.