Evolving strategies in the management of diabeticmacular edema: Clinicaltrials and current management

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Fla.
Canadian Journal of Ophthalmology (Impact Factor: 1.33). 02/2013; 48(1):22-30. DOI: 10.1016/j.jcjo.2012.11.012
Source: PubMed


Diabetic macular edema (DME) is the leading cause of vision loss in the working-age population in developed countries. Management has traditionally consisted of focal/grid macular laser, according to the guidelines established by the Early Treatment of Diabetic Retinopathy Study. More recent prospective clinical trials examining the effect of intravitreal ranibizumab in the treatment of DME-most notably, READ-2, RESOLVE, RESTORE, RISE/RIDE, and protocol I-have demonstrated improved visual outcomes with pharmacologic targeting of vascular endothelial growth factor. Similar treatment benefits have also been noted in clinical trials evaluating intravitreal bevacizumab and aflibercept (BOLT and DA VINCI, respectively). Intravitreal steroids, particularly in refractory cases, continue to have a limited role in the management of DME. In patients with symptomatic visual loss, the treatment paradigm for DME has shifted toward intravitreal pharmacotherapeutics, principally anti-vascular endothelial growth factor therapy, and this review examines the clinical trials leading to this change.

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Available from: Harry W Flynn, Nov 17, 2014
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    • "What is interesting is that in the last work of Suzuki et al. 2013, after bevacizumab injection three days before vitrectomy, apart from VEGF reduction, the authors also showed lower levels of IL-1RA, IL-5, IL-10, IL-12, IL-13 cytokines, and IFN-γ [59]. Research of group continues to analyze the possibility of using bevacizumab in the treatment of diabetic retinopathy [60, 61]. "
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