Update on Current and Future Management for Diabetic Maculopathy

Abstract

Diabetic macular edema (DME) remains the major cause of preventable blindness in the working-age population in developed countries, and screening programs are extremely important in the management of this complication of diabetic retinopathy. The introduction of modern imaging modalities and technological advances have facilitated both the early detection and the follow-up of patients with DME, particularly optical coherence tomography angiography and artificial intelligence. Intravitreal therapy is the gold standard treatment for DME, but not all patients respond equally to this therapy, and sometimes it is not easy to apply treatment protocols correctly; for these reasons, clinical practice results may differ from those of clinical trials in terms of vision gain. One approach has been to implement new treatment regimens, such as treat and extend, and new molecules and therapeutic targets are constantly being developed. The main goal of this review paper is to describe the current treatment options and management strategies for DME in Europe and to provide a brief oversight of the novel therapeutic options on the horizon.

Keywords: AntiVEGF; Diabetic macular edema; Diabetic retinopathy; Intravitreal therapy; Steroids.

Fig. 1

Fundus image of a patient showing hard exudate within 1 disc diameter from the fovea, indicating a high suspicion of macular edema

Fig. 2

Multimodal image. The fundus can be seen to have isolated microhemorrhages and microaneurysms, The optical coherence tomography (OCT) b-scan shows a few cysts within normal ranges, but OCT angiography (OCTA) confirms areas of reduced perfusion/non-perfusion and reduced vascular density in both the superficial and deep plexus. Multimodal imaging and OCTA can provide complementary information on the real-life state of the patient

Fig. 3

Top row: OCTA images showing an abnormal avascular zone of a patient referred for blurred vision; the increased foveal avascular zone (FAZ) may be a consequence of macular ischemia. Middle row: En face OCT. Bottom row: Structural or cross-sectional OCT images that are normal

Fig. 4

Multimodal image. Fundus shows hemorrhages, microaneurysms and cotton exudates, and the OCT shows an important macular edema where the subretinal fluid is clearly seen