Current Treatments in Diabetic Macular Edema

Dr. Yonca Asfuroğlu, FEBO

Ankara Bilkent City Hospital, Department of Ophthalmology, Ankara, Türkiye

ABSTRACT

Diabetic macular edema (DME) is the main vision-threatening complication of diabetic retinopathy. It is known that the incidence of DME rises with increasing disease severity and duration. Chronic hyperglycae- mia disrupts the blood-retinal barrier by damaging the antioxidant mechanisms in the long term. In addition, abnormal vascular proliferation and photoreceptor dysfunction develop and central vision is damaged. While the terminology of clinically significant macular edema according to ‘Eearly Treatment Diabetic Retinopathy Study’ classification was used previously, the term ‘central/non-central DME (ci-DME/non-ci DME)’ is pre- ferred more frequently with the use of optical coherence tomography. In recent years, the first choice in the treatment of DME is drugs inhibiting vascular endothelial growth factor (VEGF). Since 2005, Bevacizumab has been used off-label in DME. In addition, Food and Drug Administration approved Ranibizumab in 2012 and Af- libercept in 2014 for DME. Although the efficacy of these drugs has been demonstrated in many studies, new molecules with low side effect profiles that can reduce the treatment burden by residing in the vitreus for a longer period of time have started to enter our treatment practice. Among these molecules, Faricimab inhib- its VEGF-A as well as Angiopoietin-2, while Brolucizumab binds to all VEGF-A isoforms with high affinity. In addition, Ranibizumab 100 mg/ml is injected intravitreally into the eye with port delivery system mechanism, thus providing an effective drug concentration and reducing treatment intervals. While steroids and lasers were primarily used in ci-DME before the anti-VEGF era, today they are used as a supportive /complementary treatment. Especially lasers that use the subthreshold mechanism in contrast to conventional lasers have an important role in practice. With this mechanism, both excessive thermal damage is prevented and patient comfort is better. In this section, current and developing management strategies in the treatment of DME will be discussed.

Keywords: Anti-VEGF; Diabetic macular edema; Faricimab; Brolucizumab; Subtreshold laser

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