The efficacy of octreotide in the therapy of severe nonproliferative and early proliferative diabetic retinopathy - A randomized controlled study

OBJECTIVE - The pilot study examined the ability of octreotide to retard pr ogression of diabetic retinopathy (DR) and delay the need for panretinal ph otocoagulation (PRP) in patients with advanced stages of retinal disease. RESEARCH DESIGN AND METHODS - Patients with severe nonproliferative DR (NPD R) or carry non-high-risk proliferative DR (PDR) were randomly assigned to conventional diabetes management (control group, 12 patients) or to treatme nt with maximally tolerated doses of octreotide (200-5,000 mu g/day subcuta neously; 11 patients). Ocular changes in each eye were assessed at a minimu m of every 3 months for 15 months or until disease progressed to high-risk PDR requiring laser surgery. Endocrine assessments occurred at 3-month inte rvals during the study RESULTS - Only 1 of 22 eyes from patients treated with octreotide reached h igh-risk PDR requiring PRE compared with control patients, in whom 9 of 24 eyes required PRE! The decreased incidence of progression requiring laser s urgery was statistically significant if events were considered independentl y (P < 0.006). The incidence of ocular disease progression was only 27% in patients treated with octreotide compared with 42% in patients with convent ional diabetes management. This treatment effect on whether the retina wors ened approached statistical significance using repeated measures analysis ( P = 0.0605). Endocrine management was similar bent een treatment groups. Th yroxine replacement therapy was administered to maintain a euthyroid state for all octreotide-treated patients and 7 of 12 control patients. CONCLUSIONS - Our results suggest that octreotide treatment in euthyroid pa tients may retard progression of advanced DR and may delay the time to lase r surgery.