Ocular and Systemic Risk Factors for Disease Worsening Among Patients with NPDR: Post Hoc Analysis of the PANORAMA Trial

– The article is a post hoc analysis of the PANORAMA phase 3 trial, which aimed to identify baseline systemic and ocular factors associated with worsening of nonproliferative diabetic retinopathy (NPDR) and the impact of intravitreal aflibercept injection (IAI) on these associations.


– Five baseline factors were identified as being associated with increased risk of NPDR worsening in sham-treated eyes: fluorescein leakage, retinal nonperfusion area, thicker central subfield thickness, eosinophil level, and proteinuria.


– The risk of developing vision-threatening complications (VTCs), center-involved diabetic macular edema (CI-DME), or ≥ 2-step Diabetic Retinopathy Severity Scale (DRSS) worsening increased with increasing fluorescein leakage area and retinal nonperfusion area in the sham group.
– However, among IAI-treated eyes, increasing baseline fluorescein leakage or retinal nonperfusion areas did not increase the risks of NPDR worsening.
This suggests that IAI treatment can mitigate the effect of these baseline risk factors and reduce the likelihood of NPDR worsening.
– The findings of this analysis can help identify patients at increased risk of disease progression and inform closer monitoring or earlier intervention strategies for these patients.


The article concludes that increased areas of fluorescein leakage and retinal nonperfusion at baseline are key ocular biomarkers associated with NPDR worsening in sham-treated patients, but IAI treatment can mitigate this risk.

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Retina Ward of Farabi Eye Hospital