Emerging therapies in the management of macular edema: a review

Abstract

Macular edema (ME) is a major complication of several vascular and inflammatory retinal diseases. Multiple mechanisms are implicated in its development and lead to visual impairment that could be reversible (the acute stages) or not reversible (long-standing ME). For this reason, an effective approach to the treatment of ME is of paramount importance in order to prevent irreversible damage of visual function. In this review, we discuss the management of ME and, in particular, current data of studies and clinical trials about drugs that have already been evaluated or are under investigation in the management of ME. Although several diseases could lead to the development of ME, we focus on the three main causes: diabetic retinopathy (DR), retinal vein occlusion (RVO), and uveitis. The introduction into clinical practice of anti-vascular endothelial growth factor injections (ranibizumab and aflibercept) and dexamethasone implants has revolutionized the treatment of ME secondary to DR and RVO. However, new drugs are needed in the treatment of resistant forms of ME secondary to DR and RVO. A fluocinolone acetonide implant has been approved by the US Food and Drug Administration for the treatment of diabetic ME but not for RVO. Furthermore, brolucizumab and abicipar pegol have been shown to be effective in preliminary studies and have the chance to be approved soon for diabetic ME treatment. In ME secondary to uveitis, a crucial role is played by corticosteroids and non-biologic immunomodulatory drugs. However, several new biologic agents are under investigation in different clinical trials and could be important new therapeutic options in cases with a low response to first-line therapy. However, only a few of these drugs will enter the market after proving their safety and efficacy. Only after that will we be able to offer a new therapeutic option to patients affected by uveitic ME.

Risk factors for ocular complications in adult patients with uveitis

“…However, an internationally accepted approach to uveitic macular edema has yet to be established. 43…”

Intravitreal Therapy for Diabetic Macular Edema: An Update

“…Abicipar pegol (AGN-150998, MP0112, abicipar; Allergan plc/Molecular Partners) is an antagonist of VEGF-A characterized by small size, high potency, and long intravitreal half-life [ 15 , 152 ]. A phase I/II, open-label, multicenter dose-escalation trial, evaluating the safety and bioactivity of abicipar pegol in DME patients, found that there were prolonged edema reduction and improvement in vision [ 153 ].…”

“…Angiopoietins are a family of growth factors that bind to endothelial receptor tyrosine kinases [ 162 ]. Angiopoietin-2 is considered a key factor in DME pathogenesis (see Figure 1 ) [ 9 , 152 ].…”

Reading Performance in Blue Cone Monochromacy: Defining an Outcome Measure for a Clinical Trial

“…Diseases of the macula can be acquired, multifactorial, or inherited. 4 Major progress in the diagnosis and treatment of macular diseases has led to clinical trials that seek to test if proposed therapies have both safety and efficacy (e.g., Reference 5 ). A key outcome in such trials has traditionally been best-corrected visual acuity (BCVA) using Early Treatment Diabetic Retinopathy Study (ETDRS) methodology to evaluate central vision.…”