Treatment strategies for refractory diabetic macular edema: switching anti-VEGF treatments, adopting corticosteroid-based treatments, and combination therapy

Hussain, Rehan M.; Ciulla, Thomas A.

doi:10.1517/14712598.2016.1131265

Cited by 81 publications

(61 citation statements)

References 43 publications

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“…Intravitreal therapies with anti-VEGF, corticosteroids or the combination of both are presented as therapeutic options in the DME treatment, granting benefits to the functional and anatomical recovery when compared to the natural progression of the disease or to the focal laser treatment [12]. Both treatments are well tolerated and improved BCVA and anatomic outcomes in patients with DME [13].…”

Section: Discussionmentioning

confidence: 99%

Sequential Dexamethasone and Aflibercept Treatment in Patients with Diabetic Macular Edema: Structural and Functional Outcomes at 52 Weeks

et al. 2018

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Objective: The aim of this paper is to compare intravitreous aflibercept versus dexamethasone implant followed by aflibercept (sequential treatment group) in patients with diabetic macular edema (DME). Methods: We conducted an observational retrospective study in naïve DME patients, 15 treated only with aflibercept (a monthly injection for the first 5 consecutive doses, followed by an injection every 2 months), and 15 treated with a single dexamethasone implant followed by bimonthly aflibercept. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and qualitative features as well as adverse events were assessed at baseline and at 2, 6, and 12 months. Results: BCVA increased from 70.8 ± 4.1 to 83.5 ± 2.7 letters with aflibercept and from 75.6 ± 2.7 to 86.5 ± 2.5 with sequential treatment (p = 0.551). CMT decreased from 411 ± 26.1 to 288.1 ± 10.5 with aflibercept and from 411.4 ± 24.3 to 260.8 ± 17.9 in the sequential treatment group. The differences between the 2 groups, in terms of visual gain and decreased MT, were not statistically significant (p > 0.05). Nine and 6 injections and 9 and 7 monitoring visits were performed. Conclusion: Sequential treatment in DME, starting with dexamethasone and followed by aflibercept, is a promising alternative that can reduce the treatment burden in the first year without statistically significant differences in terms of visual gain and decreased MT compared to aflibercept only.

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Section: Discussionmentioning

confidence: 99%

Sequential Dexamethasone and Aflibercept Treatment in Patients with Diabetic Macular Edema: Structural and Functional Outcomes at 52 Weeks

et al. 2018

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“…Furthermore, there are few clinical trials on the role of switching from anti-VEGF to steroid therapy or addition of steroid therapy to on-going anti-VEGF therapy in DME. 22 Both the OZLASE and OZDRY studies included patients with long-standing and persistent edema despite previous laser and/or anti-VEGF therapy. 23,24 These studies did not show any visual benefit despite resolution of fluid at the end of the follow-up, using intravitreal dexamethasone implant (Ozurdex, Irvine, CA, USA).…”

Section: Discussionmentioning

confidence: 99%

Identification of time point to best define ‘sub-optimal response’ following intravitreal ranibizumab therapy for diabetic macular edema based on real-life data

Chatziralli

Santarelli

Patrao

et al. 2017

Eye

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PurposeTo determine the average time-point at which it is best to define 'sub-optimal response' after ranibizumab treatment for diabetic macular edema (DME) based on the data obtained from real-life clinical practice.MethodsIn this retrospective observational study, 322 consecutive treatment naïve eyes with DME were treated with three loading doses of intravitreal ranibizumab followed by re-treatment based on decision of the treating physician on a case-by-case basis. The demographic data, clinic-based visual acuity measurements and central subfield thickness (CST) assessed on spectral domain optical coherence tomography (OCT) were evaluated at baseline (month 0), 1, 2, 3, 6, and 12 months.ResultsOn an average, the improvement in visual acuity and CST was first seen after the loading dose. However, the maximal response in terms of proportion of patients with improvement in visual acuity and/ or CST in this cohort was observed at 12 months. Patients who presented with low visual acuity at baseline (<37 ETDRS letters) were unlikely to attain driving vision with ranibizumab therapy.ConclusionsOn an average, a 'sub-optimal response' after ranibizumab therapy is best defined at month 12 as patients may continue to improve with treatment.

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“…Currently, bevacizumab is the most cost-effective medication for control of DME21 compared with ranibizumab (40 times less expensive) or aflibercept 18 20 22. The actual compounded cost is 60 times less for ziv-aflibercept than for aflibercept, if the 4 mL ziv-aflibercept phial is divided into 40 aliquots (4 mL Zaltrap 25 mg/mL phial costs US$536 while single Eylea phial costs US$1200 in Lebanon).…”

Section: Discussionmentioning

confidence: 99%

Three-month outcome of intravitreal ziv-aflibercept in eyes with diabetic macular oedema

2016

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Treatment strategies for refractory diabetic macular edema: switching anti-VEGF treatments, adopting corticosteroid-based treatments, and combination therapy

Abstract: Introduction: The pathophysiology of diabetic macular edema (DME) is complex, involving vascular endothelial growth factor (VEGF) and other inflammatory mediators.

Cited by 81 publications

References 43 publications

Sequential Dexamethasone and Aflibercept Treatment in Patients with Diabetic Macular Edema: Structural and Functional Outcomes at 52 Weeks

Sequential Dexamethasone and Aflibercept Treatment in Patients with Diabetic Macular Edema: Structural and Functional Outcomes at 52 Weeks

Identification of time point to best define ‘sub-optimal response’ following intravitreal ranibizumab therapy for diabetic macular edema based on real-life data

Three-month outcome of intravitreal ziv-aflibercept in eyes with diabetic macular oedema

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