Date of Award
2023
Degree Type
Selective Evidence-Based Medicine Review
Degree Name
Master of Science in Health Sciences - Physician Assistant
Department
Physician Assistant Studies
Abstract
Objective: The objective of this selective EBM review is to determine whether or not combination therapy of intravitreal ranibizumab injections plus laser photocoagulation increases best corrected visual acuity (BCVA) in adults with diabetic retinopathies better than monotherapy of intravitreal ranibizumab injections.
Study Design: This EBM literature review assesses the efficacy of intravitreal ranibizumab injections in combination with laser photocoagulation by measuring best corrected visual acuity (BCVA) in patients with diabetic retinopathies and compares it to monotherapy of ranibizumab injections. All sources are published primary literature sources that have been subjected to scrutiny in peer reviewed journals.
Data Sources: Three randomized controlled trials (RCTs) were selected and analyzed.
Outcomes measured: The outcomes measured were best corrected visual acuity (BCVA) using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart. BCVA was measured for the intervention of intravitreal ranibizumab injections in combination with laser photocoagulation and the comparison of ranibizumab monotherapy at baseline and at 12 months. The data in these studies was all continuous data that was measured on a scale from worsened visual acuity to better visual acuity through letters lost or gained.
Results: Mean change from baseline in BCVA increased for both combination therapy of ranibizumab and laser photocoagulation as well as monotherapy of ranibizumab for 2 studies. 1 study had decreased BCVA for combo therapy and increased BCVA for monotherapy. In the RESPOND study by Berger et al. combination therapy of ranibizumab plus photocoagulation yielded a BCVA increase of 8.2 letters with a confidence interval (CI) of 6 through 10.4. Monotherapy of ranibizumab yielded a BCVA increase of 8.9 letters with a CI of 7 through 10.7. In the PRIDE study by Lang et al. combination therapy of ranibizumab plus photocoagulation yielded a BCVA decrease of 1.4 letters with a CI of -5.3 through 2.4. Monotherapy of ranibizumab yielded a BCVA increase of 1.6 letters with a CI of -2.3 through 5.5. In the RESTORE study by Mitchell et al. combination therapy of ranibizumab plus photocoagulation yielded a BCVA increase of 5.9 letters with a CI of 4.4 through 7.3. Monotherapy of ranibizumab yielded a BCVA increase of 6.1 letters with a CI of 4.9 through 7.3.
Conclusion: Berger (2015) and Mitchell (2011) had an increase in BCVA in both combination and monotherapy groups. Lang (2019) had increased BCVA for the monotherapy group and decreased BCVA for the combination group. Combination therapy does not increase BCVA better than monotherapy of ranibizumab injections.
Recommended Citation
Sawtelle, Daniel P., "Do ranibizumab intravitreal injections with laser therapy improve visual acuity in diabetic retinopathy patients better than monotherapy of intravitreal ranibizumab injections?" (2023). PCOM Physician Assistant Studies Student Scholarship. 668.
https://digitalcommons.pcom.edu/pa_systematic_reviews/668