Current treatment approaches in diabetic macular edema
- PMID: 17380066
- DOI: 10.1159/000098257
Current treatment approaches in diabetic macular edema
Abstract
Purpose: To review current treatment approaches in diabetic macular edema (DME).
Methods: The underlying pathopathology, classifications and diagnostic examination techniques including fluorescein angiography, optical coherence tomography and stereoscopic biomicroscopy. Treatment modalities with focal or grid argon laser photocoagulation, pars plana vitrectomy with and without peeling of the inner limiting membrane (ILM), as well as intravitreal injections using triamcinolone acetonide or novel vascular endothelial growth factor (VEGF) inhibitors are described.
Results: DME results from a series of biochemical and cellular changes, causing progressive leakage and exudation. Focal and grid photocoagulation remains the standard care for diabetic maculopathy. However, the availability of new agents raises the possibility of improvements if significant benefits can be validated in randomized clinical trials. Posterior vitreous attachments play a critical role through several mechanical or physiological mechanisms. Vitrectomy without ILM removal seems to be effective in reducing the retinal thickness and improving visual acuity.
Conclusion: A proper evaluation of the vitreous and retina is fundamental to select the most appropriate treatment approach in DME. While small microaneurysms with focal DME may be treated by conventional focal photocoagulation, diffuse DME which do not respond to grid photocoagulation may benefit from intravitreal injections using triamcinolone acetonide or novel VEGF inhibitors. Eyes with DME and additional vitreous traction may benefit from pars plana vitrectomy without ILM peeling. A combination of laser, pharmacological and surgical treatment modalities may be necessary to maintain central vision in eyes with DME.
Copyright (c) 2007 S. Karger AG, Basel.
Similar articles
-
Comparison of the magnitude and time course of macular thinning induced by different interventions for diabetic macular edema: implications for sequence of application.Ophthalmology. 2006 Oct;113(10):1713-9. doi: 10.1016/j.ophtha.2006.05.021. Epub 2006 Aug 4. Ophthalmology. 2006. PMID: 16889833
-
Posterior hyaloid changes following intravitreal triamcinolone and macular laser for diffuse diabetic macular edema.Retina. 2008 Nov-Dec;28(10):1435-42. doi: 10.1097/IAE.0b013e31817f2dae. Retina. 2008. PMID: 18628722 Clinical Trial.
-
Update on treatments for diabetic macular edema.Curr Opin Ophthalmol. 2008 May;19(3):185-9. doi: 10.1097/ICU.0b013e3282fb7c45. Curr Opin Ophthalmol. 2008. PMID: 18408491 Review.
-
Triple therapy of vitrectomy, intravitreal triamcinolone, and macular laser photocoagulation for intractable diabetic macular edema.Am J Ophthalmol. 2007 Dec;144(6):878-885. doi: 10.1016/j.ajo.2007.07.044. Epub 2007 Oct 15. Am J Ophthalmol. 2007. PMID: 17936715
-
Pars plana vitrectomy for refractory diabetic macular edema.Semin Ophthalmol. 2003 Sep;18(3):116-20. doi: 10.1076/soph.18.3.116.29813. Semin Ophthalmol. 2003. PMID: 15513471 Review.
Cited by
-
[Diabetic maculopathy and retinopathy. Functional and sociomedical significance].Ophthalmologe. 2010 Jul;107(7):628-35. doi: 10.1007/s00347-010-2176-x. Ophthalmologe. 2010. PMID: 20533047 Review. German.
-
Early Microglial Changes Associated with Diabetic Retinopathy in Rats with Streptozotocin-Induced Diabetes.J Diabetes Res. 2021 Dec 8;2021:4920937. doi: 10.1155/2021/4920937. eCollection 2021. J Diabetes Res. 2021. PMID: 34926698 Free PMC article.
-
[Monitoring of AMD patients on anti-vascular endothelial growth factor (VEGF) treatment. Practical notes on functional and anatomical examination parameters from drug approval studies, specialist information and case series].Ophthalmologe. 2008 Feb;105(2):125-38, 140-2. doi: 10.1007/s00347-008-1702-6. Ophthalmologe. 2008. PMID: 18256841 Review. German.
-
Pre-operative versus post-operative intravitreal aflibercept injection for management of DME in patients undergoing cataract surgery.Graefes Arch Clin Exp Ophthalmol. 2023 Nov;261(11):3223-3229. doi: 10.1007/s00417-023-06138-6. Epub 2023 Jun 17. Graefes Arch Clin Exp Ophthalmol. 2023. PMID: 37329361
-
Intraocular sustained-release delivery systems for triamcinolone acetonide.Pharm Res. 2009 Apr;26(4):770-84. doi: 10.1007/s11095-008-9812-z. Epub 2009 Jan 28. Pharm Res. 2009. PMID: 19184374 Review.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous