Diabetic Macular Edema: Options for Adjunct Therapy

Abstract

Diabetes mellitus (DM) is a chronic disease that affects 387 million people worldwide. Diabetic retinopathy (DR), a common complication of DM, is the main cause of blindness in the active population. Diabetic macular edema (DME) may occur at any stage of DR, and is characterized by vascular hyperpermeability accompanied by hard exudates within the macula. Medical and surgical therapies have dramatically reduced the progression of DR, and timely intervention can reduce the risk of severe vision loss by more than 90 %. In 2012, intravitreal ranibizumab became the first antivascular endothelial growth factor (anti-VEGF) agent approved for DME and, since then, many reports of the use of ranibizumab for DME have been promising. Randomized, prospective, multicenter clinical trials-most notably, RESOLVE, READ-2, RISE/RIDE, RESTORE, DRCR.net protocol I, and RETAIN-reported improvements in best-corrected visual acuity and decreased central retinal thickness as measured with optical coherence tomography in patients with DME. Similar treatment benefits have also been noted in clinical trials evaluating intravitreal aflibercept and bevacizumab (DAVINCI, VISTA/VIVID, and BOLT) and more recently DRCR.net protocol T. Intravitreal steroids (dexamethasone intravitreal implant and fluocinolone acetonide), particularly in refractory cases, also play a significant role in the management of DME (MEAD/CHAMPLAIN and FAMOUS/FAME studies). In summary, over the last 5 years, blocking VEGF and inflammation has been shown to improve visual outcomes in patients with macular edema due to DM, revolutionizing the treatment of center-involved DME and establishing a new standard of care.

Abrus precatorius Leaf Extract Reverses Alloxan/Nicotinamide-Induced Diabetes Mellitus in Rats through Hormonal (Insulin, GLP-1, and Glucagon) and Enzymatic (α-Amylase/α-Glucosidase) Modulation

“…Epidemiologically, it is reported that DM affects over 387 million people worldwide [ 4 ]. This provisional estimate is projected to increase to 592 million by the year 2035 [ 5 ].…”

Fluorescence Lifetime Imaging Ophthalmoscopy (FLIO)

“…They may damage the vascular endothelium and, subsequently, also affect the pericytes. This leads to a disruption of the BRB and can result in diabetic macular edema, one of the most sight-threatening complications of diabetes [164,165]. Furthermore, AGEs have procoagulant potential contributing to capillary occlusion which is typical for diabetic retinopathy [158].…”

Ocular Complications of Diabetes and Therapeutic Approaches

“…Ocriplasmin (ThromboGenics NV, Iselin, NH) is recombinant human plasmin that digests fibronectin, laminin, and collagen in the vitreous to weaken adhesions at the vitreoretinal surface and release the retinal vessels that have grown into the vitreous. Ocriplasmin has been FDA approved for vitreomacular traction when associated with a macular hole ≤ 400 um [ 170 , 171 ].…”