• Tatsuro Ishibashi, Xiaoxin Li, Adrian Koh, Timothy Y Y Lai, Fenq-Lih Lee, Won-Ki Lee, Zhizhong Ma, Masahito Ohji, Nikolle Tan, Sung Bok Cha, Jila Shamsazar, C Lillian Yau, and REVEAL Study Group.
• Department of Ophthalmology, Kyushu University Hospital, Fukuoka, Japan.
• Ophthalmology. 2015 Jul 1; 122 (7): 1402-15.

ObjectiveThe primary study hypothesis was that ranibizumab 0.5 mg monotherapy or combined with laser is superior to laser monotherapy based on mean average change in best-corrected visual acuity (BCVA) over 12 months in Asian patients with visual impairment resulting from diabetic macular edema (DME).DesignA 12-month, randomized, double-masked, multicenter, laser-controlled, phase III study.ParticipantsThree hundred ninety-six patients aged ≥18 years, with type 1 or 2 diabetes mellitus, BCVA of 78-39 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, and visual impairment resulting from DME.MethodsPatients were randomized to ranibizumab + sham laser (n = 133), ranibizumab + active laser (n = 132), or sham injection + active laser (n = 131). Ranibizumab/sham injections were administered on day 1 and continued monthly. As of month 3, monthly injections were continued if stable vision was not reached. Treatment was reinitiated if BCVA decreased because of DME progression. Active/sham laser was administered on day 1 and thereafter according to ETDRS guidelines.Main Outcome MeasuresAverage change in BCVA from baseline to months 1 through 12, central retinal subfield thickness (CRST), and safety over 12 months.ResultsRanibizumab monotherapy or combined with laser was superior to laser in improving mean average change in BCVA from baseline to months 1 through 12 (+5.9 and +5.7 vs +1.4 letters). At month 12, greater proportion of patients gained ≥15 letters with ranibizumab and ranibizumab + laser compared with laser (18.8% and 17.8% vs 7.8%). Mean CRST reduced significantly from baseline to month 12 with ranibizumab (-134.6 μm) and ranibizumab + laser (-171.8 μm) versus laser (-57.2 μm). Patients received a mean of 7.8 and 7.0 ranibizumab injections in the ranibizumab and ranibizumab + laser arms, respectively, and 1.5-1.9 active laser across treatment arms over 12 months. Conjunctival hemorrhage was the most common ocular, whereas nasopharyngitis and hypertension were the most common nonocular adverse events. Ranibizumab was not associated with any cases of cerebrovascular hemorrhage and cerebrovascular ischemia. No death related to study treatment was reported.ConclusionsRanibizumab monotherapy or combined with laser showed superior BCVA improvements over laser treatment alone in Asian patients with visual impairment resulting from DME. No new ocular or nonocular safety findings were observed and treatment was well tolerated over 12 months.Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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