Pharmacotherapies for diabetic retinopathy: present and future

Abstract

Diabetic retinopathy remains a major cause of worldwide preventable blindness. Measures to avoid blindness include medical management (control of blood sugar, blood pressure, and serum lipids) and ocular management (laser photocoagulation and pars plana vitrectomy). Adjunctive pharmacologic therapies (intravitreal triamcinolone acetonide and anti-vascular endothelial growth factor agents) have shown early promise in the treatment of both diabetic macular edema and proliferative diabetic retinopathy. Other medications under investigation include the fluocinolone acetonide implantable device, extended-release dexamethasone implant, oral ruboxistaurin, and intravitreal hyaluronidase.

Figure 1

Intravitreal triamcinolone acetonide for diabetic macular edema. A patient presented with diabetic macular edema, visual acuity 20/60. Fundus photography (a) and optical coherence tomography (OCT) (b, c) are shown. The patient was treated with intravitreal triamcinolone acetonide. One month after treatment, visual acuity improved to 20/40, with improvement of macular edema on photography (d) and OCT (e, f). Four months after treatment, visual acuity improved to 20/20, with further improvement of macular edema on photography (g) and OCT (h, i).

Figure 2

Intravitreal bevacizumab for proliferative diabetic retinopathy. A patient presented with proliferative diabetic retinopathy. Fundus photography (a) and fluorescein angiography (b) are shown. The patient was treated with intravitreal bevacizumab. Followup fluorescein angiography demonstrated improvement in angiographic leakage (c). Panretinal photocoagulation was then applied (d). (Case courtesy of Geeta Lalwani, MD, and Carmen A. Puliafito, MD, MBA.)