Managing diabetic macular edema: The leading cause of diabetes blindness

Abstract

Diabetic macular edema (DME) is the leading cause of blindness in young adults in developed countries, affecting 12% of type 1 and 28% of type 2 diabetic patients. The gold standard DME treatment should be based on a good control of glycemia along with control of lipids and renal function. However, despite the systemic metabolic control values being essential for patients with diabetic retinopathy (DR), it has proven to be insufficient for DME if it appears. With these patients, additional measures are needed in order to avoid the subsequent loss of vision. While laser treatment of DME has been the only valid treatment so far, it has been inadequate in chronic cases. The introduction of new treatments, such as intravitreal corticosteroids or anti-VEGF drugs, have recently shown their safety and efficacy and together with laser photocoagulation are becoming the treatments of choice in the management of DME.

Visual Outcome After Intravitreal Bevacizumab Depends on the Optical Coherence Tomographic Patterns of Patients With Diffuse Diabetic Macular Edema

“…In general, macular laser treatment is believed to result in a better visual outcome than IVB or intravitreal injection of triamcinolone acetonide. 32 However, subtype classification of DDME may reveal other results. Varying treatment according to different morphologic types may reveal another way to reduce DDME.…”

“…33,34 Thus, the gold standard for DDME treatment should be good control of hyperglycemia along with control of lipids and renal function. 32 Intravitreal bevacizumab is likely to be more effective at obtaining better results in the reduction of DDME in the earlier stages of SDRT and CME. Although our results are preliminary and we had a limited number of cases, our study indicates that the relationships between visual acuity, FT, and the effectiveness of IVB in reducing DDME are dependent on the morphologic characteristics identified with OCT images.…”

Baseline Choroidal Thickness as a Predictor for Response to Anti–Vascular Endothelial Growth Factor Therapy in Diabetic Macular Edema

“…1 While alterations in retinal vasculature resulting in compromise of the blood-retinal barrier have been demonstrated to play a critical role in the pathophysiology of the disease, changes in the underlying choroidal vasculature may also play a contributing role.…”

Clinical Decision-Making when Treating Diabetic Macular Edema Patients with Dexamethasone Intravitreal Implants

“…Among such patients, the prevalence of diabetic retinopathy varies depending on the sample analyzed and the meth od used. Currently, the prevalence of diabetic retinopa thy and that of vision-threatening diabetic retinopathy among adult diabetics in the USA is estimated to be 28.5 and 4.4%, respectively [11], and DME is the leading cause of vision loss associated with DM, affecting 12% of patients with type 1 DM and 28% of patients with type 2 DM [12]. In fact, DME is estimated to affect 7% of diabetic patients, which means that about 21 million people worldwide suffer from this type of visual impairment [12-14].…”