Diabetic Macular Edema: Traditional and Novel Treatment (original) (raw)
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Evidence-Based Treatment Modalities in Diabetic Macular Edema
2019
Diabetic macular edema is an important cause of visual loss. Previously, the vision could be stabilized with focal/grid laser photocoagulation therapies in diabetic macular edema with central involvement. Recently, it has become possible to attain visual gains with the help of intravitreal corticosteroids and anti-VEGF agents.
BioMed research international, 2015
Objective. To compare the efficacy of different therapies in the treatment of diabetic macular edema (DME). Design. Nonrandomized, multicenter clinical study. Participants. 86 retina specialists from 29 countries provided clinical information on 2,603 patients with macular edema including 870 patients with DME. Methods. Reported data included the type and number of treatment(s) performed, the pre-and posttreatment visual acuities, and other clinical findings. The results were analyzed by the French INSEE (National Institute of Statistics and Economic Studies). Main Outcome Measures. Mean change of visual acuity and mean number of treatments performed. Results. The change in visual acuity over time in response to each treatment was plotted in second order polynomial regression trend lines. Intravitreal triamcinolone monotherapy resulted in some improvement in vision. Treatment with threshold or subthreshold grid laser also resulted in minimal vision gain. Anti-VEGF therapy resulted in more significant visual improvement. Treatment with pars plana vitrectomy and internal limiting membrane (ILM) peeling alone resulted in an improvement in vision greater than that observed with anti-VEGF injection alone. In our DME study, treatment with vitrectomy and ILM peeling alone resulted in the better visual improvement compared to other therapies.
Current status in diabetic macular edema treatments
World journal of diabetes, 2013
Diabetes is a serious chronic condition, which increase the risk of cardiovascular diseases, kidney failure and nerve damage leading to amputation. Furthermore the ocular complications include diabetic macular edema, is the leading cause of blindness among adults in the industrialized countries. Today, blindness from diabetic macular edema is largely preventable with timely detection and appropriate interventional therapy. The treatment should include an optimized control of glycemia, arterial tension, lipids and renal status. The photocoagulation laser is currently restricted to focal macular edema in some countries, but due the high cost of intravitreal drugs, the use of laser treatment for focal and diffuse diabetic macular edema (DME), can be valid as gold standard in many countries. The intravitreal anti vascular endothelial growth factor drugs (ranibizumab and bevacizumab), are indicated in the treatment of all types of DME, but the correct protocol for administration should b...
IOSR Journals , 2019
Purpose:To assess the effect of central macular thickness (CMT) measured by optical coherence tomography (OCT) on the response to treatment in diabetic macular edema. Methods: This was Prospective Interventional Study conducted in patients visiting the outdoor unit of Department of Ophthalmology, Maharani Laxmi Bai Medical College Jhansi, during the period of 13 months from March 2017 to March 2018. This study included patients with age above 21 years, with diabetes, which is defined as a fasting plasma glucose of more than or equal to 126 mg/dl or a 2-hour post glucose load plasma glucose of more than or equal to 200 mg/dl or a random plasma glucose of more than or equal to 200 mg/dl in the presence of symptoms of hyperglycemia, and duration > 5 years,and those who were physically fit to undergo a dilated fundus examination and OCT evaluation. Results: In this study the mean baseline Best corrected visual acuity right eye affected with DME is 0.822+0.249 and in left eye is 0.863+0.210.The follow up mean visual acuity BCVA as per log MAR right eye affected with DME at 1 month is 0.574+0.230 and, at 6 months is 0.379+0.166. The p value was <0.05, as calculated with the help of paired t-test, indicating that there was a significant difference in Best corrected visual acuity.The follow up mean visual acuity BCVA as per log MAR left eye affected with DME at 1 month is 0.544+0.185 and, at 6 months is 0.347+0.188. The p value was <0.05, as calculated with the help of paired t-test, indicating that there was a significant difference in Best corrected visual acuity.In our study baseline mean central macular thickness in right eye affected with DME are 664.6+31.63 (µm) and, At 1 month the follow up mean central macular thickness (CMT) thickness right eye affected with DME are 467.4+51.41(µm). After 3 months, CMT is 376.4±55.63 (µm), After 6 months of follow up the CMT is 299.3±47.20 (µm).We also measured the baseline mean central macular thickness in left eye affected with DME is 653.6+36.78 µm, At 1 month the follow up mean central macular thickness (CMT) thickness left eye affected with DME was 464.3+61.44 µm. After 3 months, CMT reduced to 370.4±73.25 µm, After 6 months of follow up the CMT reduced to 302.4±47.03 µm. The p value was <0.05, as calculated with the help of paired t-test, indicating that there was a significant difference in mean central macular thickness. conclusion: Macular edema after treatment was assessed by improvement in mean CMT and mean BCVA, which correlated with each other.In this study intravitreal ranibizumab or bevacizumab treatment provides superior visual outcomes compared to conventional laser treatment. Intravitreal ranibizumab with laser has been shown to be more effective compare to focal / grid laser alone for the treatment of DME. Intravitreal triamcinolone with focal/grid photocoagulation has been shown to be more effective than laser alone. we concluded that triamcinolone intravitreal injection has not been found to be superior to focal / grid photocoagulation or Anti-VEGF treatment.
BioMed Research International, 2015
Objective. To compare the efficacy of different therapies in the treatment of diabetic macular edema (DME). Design. Nonrandomized, multicenter clinical study. Participants. 86 retina specialists from 29 countries provided clinical information on 2,603 patients with macular edema including 870 patients with DME. Methods. Reported data included the type and number of treatment(s) performed, the pre-and posttreatment visual acuities, and other clinical findings. The results were analyzed by the French INSEE (National Institute of Statistics and Economic Studies). Main Outcome Measures. Mean change of visual acuity and mean number of treatments performed. Results. The change in visual acuity over time in response to each treatment was plotted in second order polynomial regression trend lines. Intravitreal triamcinolone monotherapy resulted in some improvement in vision. Treatment with threshold or subthreshold grid laser also resulted in minimal vision gain. Anti-VEGF therapy resulted in more significant visual improvement. Treatment with pars plana vitrectomy and internal limiting membrane (ILM) peeling alone resulted in an improvement in vision greater than that observed with anti-VEGF injection alone. In our DME study, treatment with vitrectomy and ILM peeling alone resulted in the better visual improvement compared to other therapies.
Update on the Management of Diabetic Macular Edema
US Ophthalmic Review, 2017
Diabetic macular edema (DME) is a treatable sequela of diabetic retinopathy and a significant cause of visual morbidity among working age individuals worldwide. While anti-vascular endothelial growth factor (anti-VEGF) agents are first-line agents in the management of DME, corticosteroids and laser therapy can play a role as well. Despite a growing understanding of best clinical practices, many patients respond unpredictably to therapy. This article will briefly review current treatment modalities and discuss future treatment options for managing DME.
Challenges in Diabetic Macular Edema Management: An Expert Consensus Report
Clinical Ophthalmology, 2021
Purpose: This paper aimed to present daily-practice recommendations for the management of diabetic macular edema (DME) patients based on available scientific evidence and the clinical experience of the consensus panel. Methods: A group of Spanish retina experts agreed to discuss different aspects related with the clinical management of DME patients. Results: Panel was mainly focused on therapeutic objectives in DME management; definition terms; and role of biomarkers as prognostic and predictive factors to intravitreal treatment response. The panel recommends to start DME treatment as soon as possible in those eyes with a visual acuity less than 20/25 (always according to the retina unit capacity). Naïve patient was defined, in a strict manner, as a patient who, up to that moment, had never received any treatment. A refractory DME patient may be defined as the one who did not achieve a complete resolution of the disease, regardless of the treatment administered. Different optical coherence tomography biomarkers, such as disorganization of the retinal inner layers, hyperreflective dots, and cysts, have been identified as prognostic factors. Conclusion: This document has sought to lay down a set of recommendations and to identify key issues that may be useful for the daily management of DME patients.
Current Opinion in Ophthalmology, 2017
Purpose of review To provide an historical review of the Early Treatment Diabetic Retinopathy Study (ETDRS) in the management of diabetic macular edema (DME), and to discuss its relevance to the management of DME. Recent findings The ETDRS reported that argon laser treatment is beneficial in the management of 'clinically significant' DME. The study provided guidelines for the treatment with focal and/or grid laser based on fluorescein angiographic patterns. In today's world, with the advent of optical coherence tomography, 'clinically significant' DME is now classified into center-involved DME (CI DME) and noncenter-involved DME (non-CI DME). Modified ETDRS focal/grid laser photocoagulation has been utilized in more recent clinical trials [diabetic retinopathy clinical research (DRCR) Protocols I and T] in combination with intravitreal injections. Summary The ETDRS provided outcomes data for DME, both untreated and following laser therapy. In the management of patients with DME today, the modified ETDRS focal/grid laser photocoagulation treatments remain relevant in combination with anti-vascular endothelial growth factor (anti-VEGF) therapy as ophthalmologists and their patients choose how best to treat DME. Ongoing studies in eyes with DME, nonproliferative diabetic retinopathy, and good visual acuity will help further define the place of modified ETDRS focal/grid laser in the treatment of DME.
Treatment of Diabetic Macular Edema
Current Diabetes Reports, 2019
Purpose of Review Diabetes mellitus is a global epidemic which is growing in prevalence, and diabetic macular edema (DME) is a leading cause of visual impairment among patients affected by this disease. Our objective is to review current and upcoming therapeutic approaches to DME. Recent Findings Once considered the gold standard in treatment of DME, focal/grid laser is now reserved mostly for non-centerinvolving DME, while anti-vascular endothelial growth factor (anti-VEGF) therapy has become the first-line treatment. However, suboptimal responders to anti-VEGF and the burden of frequent injections have stimulated the development of novel approaches. Corticosteroids can be effective in treating DME, but adverse effects such as intraocular pressure elevation and cataract formation must be considered. Emerging therapeutics and drug delivery systems in the pipeline offer exciting potential solutions to this vision-threatening disease. Summary Multiple types of therapeutics targeting various pathways implicated in the pathogenesis of DME may help lessen the global burden of vision loss from diabetes.