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Guidelines for the Management of Center-Involving Diabetic Macular Edema: Treatment Options and Patient Monitorization

Diabetic macular edema (DME) is the main cause of visual impairment associated with diabetic retinopathy (DR) and macular laser, during approximately three decades, and was the single treatment option. More recently, intravitreous injections of anti-angiogenics and corticosteroids modified the treat...

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Autores principales: Figueira, João, Henriques, José, Carneiro, Ângela, Marques-Neves, Carlos, Flores, Rita, Castro-Sousa, João Paulo, Meireles, Angelina, Gomes, Nuno, Nascimento, João, Amaro, Miguel, Silva, Rufino
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8331083/
https://www.ncbi.nlm.nih.gov/pubmed/34354341
http://dx.doi.org/10.2147/OPTH.S318026
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author Figueira, João
Henriques, José
Carneiro, Ângela
Marques-Neves, Carlos
Flores, Rita
Castro-Sousa, João Paulo
Meireles, Angelina
Gomes, Nuno
Nascimento, João
Amaro, Miguel
Silva, Rufino
author_facet Figueira, João
Henriques, José
Carneiro, Ângela
Marques-Neves, Carlos
Flores, Rita
Castro-Sousa, João Paulo
Meireles, Angelina
Gomes, Nuno
Nascimento, João
Amaro, Miguel
Silva, Rufino
author_sort Figueira, João
collection PubMed
description Diabetic macular edema (DME) is the main cause of visual impairment associated with diabetic retinopathy (DR) and macular laser, during approximately three decades, and was the single treatment option. More recently, intravitreous injections of anti-angiogenics and corticosteroids modified the treatment paradigm associated with significant vision improvements. Nevertheless, not all patients respond satisfactorily to anti-VEGF or corticosteroid injections, so an adequate treatment choice and a prompt switch in therapeutic class is recommended. Several algorithms and guidelines have been proposed for treating center involving DME to improve patients’ vision and quality of life. However, in Portugal, such guidelines are lacking. The present review aimed to provide guidelines for the treatment options and patient monitorization in the management of center-involving DME. We recommend anti-vascular endothelial growth factor (VEGF) as first-line therapy after a clinical evaluation accompanied by a rigorous metabolic control. Depending on the response obtained after 3–6 monthly intravitreal injections we suggest switching outside the class in case of a non-responder, maintaining the anti-VEGF-therapy in responders to anti-angiogenics. The treatment regimen for Dexamethasone intravitreal implant (DEXii) should be pro-re-nata with bi-monthly or quarterly monitoring visits (with a scheduled visit at 6–8 weeks after DEXii for intraocular pressure control). If a patient does not respond to DEXii, switch again to anti-VEGF therapy, combine therapies, or re-evaluate patients diagnose. There is a resilient need to understand the disease, its treatments, regimens available, and convenience for all involved to propose an adequate algorithm for the treatment of diabetic retinopathy (DR) and DME in an individualized regimen. Further understanding of the contributing factors to the development and progression of DR should bring new drug discoveries for more effective and better-tolerated treatments.
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spelling pubmed-83310832021-08-04 Guidelines for the Management of Center-Involving Diabetic Macular Edema: Treatment Options and Patient Monitorization Figueira, João Henriques, José Carneiro, Ângela Marques-Neves, Carlos Flores, Rita Castro-Sousa, João Paulo Meireles, Angelina Gomes, Nuno Nascimento, João Amaro, Miguel Silva, Rufino Clin Ophthalmol Review Diabetic macular edema (DME) is the main cause of visual impairment associated with diabetic retinopathy (DR) and macular laser, during approximately three decades, and was the single treatment option. More recently, intravitreous injections of anti-angiogenics and corticosteroids modified the treatment paradigm associated with significant vision improvements. Nevertheless, not all patients respond satisfactorily to anti-VEGF or corticosteroid injections, so an adequate treatment choice and a prompt switch in therapeutic class is recommended. Several algorithms and guidelines have been proposed for treating center involving DME to improve patients’ vision and quality of life. However, in Portugal, such guidelines are lacking. The present review aimed to provide guidelines for the treatment options and patient monitorization in the management of center-involving DME. We recommend anti-vascular endothelial growth factor (VEGF) as first-line therapy after a clinical evaluation accompanied by a rigorous metabolic control. Depending on the response obtained after 3–6 monthly intravitreal injections we suggest switching outside the class in case of a non-responder, maintaining the anti-VEGF-therapy in responders to anti-angiogenics. The treatment regimen for Dexamethasone intravitreal implant (DEXii) should be pro-re-nata with bi-monthly or quarterly monitoring visits (with a scheduled visit at 6–8 weeks after DEXii for intraocular pressure control). If a patient does not respond to DEXii, switch again to anti-VEGF therapy, combine therapies, or re-evaluate patients diagnose. There is a resilient need to understand the disease, its treatments, regimens available, and convenience for all involved to propose an adequate algorithm for the treatment of diabetic retinopathy (DR) and DME in an individualized regimen. Further understanding of the contributing factors to the development and progression of DR should bring new drug discoveries for more effective and better-tolerated treatments. Dove 2021-07-30 /pmc/articles/PMC8331083/ /pubmed/34354341 http://dx.doi.org/10.2147/OPTH.S318026 Text en © 2021 Figueira et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Review
Figueira, João
Henriques, José
Carneiro, Ângela
Marques-Neves, Carlos
Flores, Rita
Castro-Sousa, João Paulo
Meireles, Angelina
Gomes, Nuno
Nascimento, João
Amaro, Miguel
Silva, Rufino
Guidelines for the Management of Center-Involving Diabetic Macular Edema: Treatment Options and Patient Monitorization
title Guidelines for the Management of Center-Involving Diabetic Macular Edema: Treatment Options and Patient Monitorization
title_full Guidelines for the Management of Center-Involving Diabetic Macular Edema: Treatment Options and Patient Monitorization
title_fullStr Guidelines for the Management of Center-Involving Diabetic Macular Edema: Treatment Options and Patient Monitorization
title_full_unstemmed Guidelines for the Management of Center-Involving Diabetic Macular Edema: Treatment Options and Patient Monitorization
title_short Guidelines for the Management of Center-Involving Diabetic Macular Edema: Treatment Options and Patient Monitorization
title_sort guidelines for the management of center-involving diabetic macular edema: treatment options and patient monitorization
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8331083/
https://www.ncbi.nlm.nih.gov/pubmed/34354341
http://dx.doi.org/10.2147/OPTH.S318026
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