Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory

Romero-Aroca, Pedro; Baget-Bernaldiz, Marc; Ríos, Alicia; López-Gálvez, Maribel; Navarro-Gil, Raúl; Verges, Raquel

doi:10.1155/2016/2156273

Cited by 310 publications

(284 citation statements)

References 80 publications

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“…The importance of this balance goes hand-in-hand with the importance of the chronicity of DME in the variability observed in patient response to anti-VEGF treatment, because it is generally believed that DME is primarily mediated by VEGF in its early phase, whereas the involvement of other cytokines and inflammatory mechanisms becomes more important in chronic disease. 2 Low-grade inflammation has been postulated to be responsible for the retinal damage that occurs in chronic DME. 2 It may be important to treat the inflammatory component of DME in patients who do not respond adequately to anti-VEGF treatment.…”

Section: Discussionmentioning

confidence: 99%

“…2 Low-grade inflammation has been postulated to be responsible for the retinal damage that occurs in chronic DME. 2 It may be important to treat the inflammatory component of DME in patients who do not respond adequately to anti-VEGF treatment. Studies have demonstrated the effectiveness of corticosteroid treatment in long-standing and refractory DME.…”

Section: Discussionmentioning

confidence: 99%

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Use of Corticosteroids in the Treatment of Patients With Diabetic Macular Edema Who Have a Suboptimal Response to Anti-VEGF: Recommendations of an Expert Panel

Regillo¹,

Callanan²,

Diana³

et al. 2017

Ophthalmic Surg Lasers Imaging Retina

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BACKGROUND AND OBJECTIVE: Guidance on the use of corticosteroids in the treatment of diabetic macular edema (DME) is lacking. This study aimed to develop a clinically recommended treatment paradigm for DME with emphasis on the role of corticosteroids. PATIENTS AND METHODS: An expert panel of nine retinal specialists in the United States developed consensus recommendations for DME treatment through a modified Delphi process. RESULTS: The panelists typically use intravitreal injections of vascular endothelial growth factor (VEGF) antagonists as first-line treatment of DME and switch patients with an inadequate response to anti-VEGF therapy (failure of best-corrected visual acuity to improve to 20/40 or better because of edema after three to six monthly injections, or a less-than-50% reduction in excess macular thickness after three to four monthly injections) to intravitreal corticosteroid treatment. CONCLUSION: Intravitreal corticosteroids have a potentially useful role in the treatment of patients with DME who have an inadequate response to intravitreal anti-VEGF therapy. [ Ophthalmic Surg Lasers Imaging Retina. 2017;48:291–301.]

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of Corticosteroids in the Treatment of Patients With Diabetic Macular Edema Who Have a Suboptimal Response to Anti-VEGF: Recommendations of an Expert Panel

Regillo¹,

Callanan²,

Diana³

et al. 2017

Ophthalmic Surg Lasers Imaging Retina

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“…Tokom dužeg trajanja bolesti hiperglikemija dovodi do oštećenja endotela malih krvnih sudova, što se ogleda u gubitku pericita i zadebljanju bazalne membrane, a za posledicu ima povećanu propustljivost kapilara za sastojke plazme i sužavanje lumena kapilara (5). Patološka propustljivost kapilarne mreže, koja se klinički manifestuje kao edem makule, dovodi do zadrža-vanja tečnosti i lipoproteina u tkivu, što remeti arhitektoniku makule i ima za posledicu smanjenje oštrine vida (6). Edem retine lokalizovan van makule neprimetan je za pacijente jer ne smanjuje oštrinu vida (7).…”

Section: Uvodunclassified

“…Alasil i saradnici (23) navode da ne postoji korelacija između CMD i oštrine vida, ali da CMD predstavlja prognostički faktor. U našoj studiji ne postoji statistički značajna povezanost između poboljšanja oštrine vida i smanjenja centralne makularne debljine, što je u skladu sa nalazima Alasila i saradnika (23) i Romera i saradnika (6).…”

Section: Diskusijaunclassified

Efficacy and safety of triamcinolone acetonide posterior subtenon injection in patients with diabetic maculopathy

Jovanovic¹,

Jovanović²,

Kujundzic³

et al. 2017

Med podmladak

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Introduction: Diabetic maculopathy (DM) is the main cause of visual impairment of the working population. Optical coherence tomography and fluorescein angiography give us a precise insight into retinal changes. In recent years, pharmacological treatment of DM is increasing. Posterior subtenon application is accompanied by a smaller percentage of complications compared to intravitreal application. Aim: The aim is to assess the efficacy and safety of triamcinolone acetonide (TA) posterior subtenon injection in the treatment of DM, by measuring intraocular pressure (IOP), central macular thickness (CMT) and visual acuity, before and two months after. Material and methods: The retrospective study included 49 patients admitted during 2016, for posterior subtenon injection of TA in the DM treatment, at Daily Hospital, for the treatment of vascular diseases of the eye and the macula Department of Ophthalmology, Clinical Center of Serbia. Data were collected from medical records on gender, age, type of retinopathy and visual acuity, IOP and CMT, before and two months after intervention. Results: The average age of patients was 63 ± 9.5 years. Out of 49 patients tested, 30.61% were female and 69.39 % were male. The frequency of non-proliferative diabetic retinopathy (NPDR) in the study was 53.6%. There was a statistically significant difference in visual acuity and CMT, before and two months after the intervention, but there was no correlation between the improvement of visual acuity and CMT reduction. There was no statistically significant difference in IOP, before and two months after intervention. Conclusion:The most common type of diabetic retinopathy in this study was NPDR. After posterior subtenon application of TA, there was a significant increase in visual acuity and CMT reduction, but reduction of CMT is not connected with the increase of visual acuity. Posterior subtenon TA application is not accompanied by a significant increase in IOP, and it is an effective and relatively safe way of treating DM.

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“…14 The mechanisms of action of these agents include nonspecific anti-inflammatory properties 14 ; VEGF is the primary mediator of the breakdown in blood-retinal barrier characteristic of DME. 2,15,16 The intravitreal anti-VEGF therapies, ranibizumab (Lucentis; Genentech, Inc., San Francisco, CA, USA) and aflibercept (Eylea; Regeneron, Inc., Tarrytown, NY, USA), have become the standard of care for DME, with functional and anatomical benefits evident in terms of improved visual acuity and associated decreases in retinal thickness. [17][18][19][20] Nevertheless, intravitreal therapy has limitations, and patients risk pain, short-and long-term increases in intraocular pressure (IOP), subconjunctival/vitreal hemorrhages, vitreous floaters, retinal detachment, and endophthalmitis.…”

mentioning

confidence: 99%

A CCR2/5 Inhibitor, PF-04634817, Is Inferior to Monthly Ranibizumab in the Treatment of Diabetic Macular Edema

Gale

Berger²,

Gilbert

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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Citation: Gale JD, Berger B, Gilbert S, et al. A CCR2/5 inhibitor, PF-04634817, is inferior to monthly ranibizumab in the treatment of diabetic macular edema. Invest Ophthalmol Vis Sci. 2018;59:2659-2669. https://doi.org/10.1167/iovs.17-22731 PURPOSE. Ligands for the proinflammatory C-C chemokine receptor types 2 and 5 (CCR2 and CCR5) are elevated in the eyes of patients with diabetic macular edema (DME). We evaluated the efficacy and safety of PF-04634817, an oral CCR2/5 dual antagonist, versus intravitreal ranibizumab, in adult subjects with DME. METHODS.In this phase II, randomized, placebo-controlled, double-masked study, eligible subjects ( ‡18 years of age) had type 1 or 2 diabetes and DME with best-corrected visual acuity (BCVA) of 20/32 or worse (letter score 78), and up to 20/320 or better ( ‡24 letter score), in the study eye. Subjects were assigned randomly 1:1 to once-daily (QD) oral PF-04634817 200 mg plus masked sham therapy as placebo or monthly intravitreal ranibizumab 0.3/0.5 mg plus QD oral placebo. The primary objective was to evaluate the efficacy of PF-04634817 compared with ranibizumab in change from baseline in BCVA after 12 weeks in a noninferiority design. Noninferiority was based on BCVA 80% confidence interval (CI): there had to be a less than three letter loss in the PF-04634817 arm compared with the ranibizumab arm. RESULTS.A total of 199 subjects were randomized. Least squares mean difference in change in BCVA from baseline to week 12 in the study eye for the PF-04634817 arm was À2.41 letters (80% CI: À3.91, À0.91; P ¼ 0.04) compared with ranibizumab. PF-04634817 was well tolerated.CONCLUSIONS. Treatment with oral CCR2/5 receptor dual antagonist PF-04634817 was associated with a modest improvement in BCVA, but did not meet the predefined noninferiority criteria compared with intravitreal ranibizumab.

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Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory

Cited by 310 publications

References 80 publications

Use of Corticosteroids in the Treatment of Patients With Diabetic Macular Edema Who Have a Suboptimal Response to Anti-VEGF: Recommendations of an Expert Panel

Use of Corticosteroids in the Treatment of Patients With Diabetic Macular Edema Who Have a Suboptimal Response to Anti-VEGF: Recommendations of an Expert Panel

Efficacy and safety of triamcinolone acetonide posterior subtenon injection in patients with diabetic maculopathy

A CCR2/5 Inhibitor, PF-04634817, Is Inferior to Monthly Ranibizumab in the Treatment of Diabetic Macular Edema

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