Guidelines for the management of center-involving diabetic macular edema: Treatment options and patient monitorization

João Figueira, José Henriques, Ângela Carneiro, Carlos Marques-Neves, Rita Flores, João Paulo Castro-Sousa, Angelina Meireles, Nuno Gomes, João Nascimento, Miguel Amaro, Rufino Silva

Research output: Contribution to journalReview articlepeer-review

Abstract

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 corticoster-oids 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.

Original languageEnglish
Pages (from-to)3221-3230
Number of pages10
JournalCLINICAL OPHTHALMOLOGY
Volume15
DOIs
Publication statusPublished - 2021

Keywords

  • Anti-vascular endothelial growth factor
  • Center-involving diabetic macular edema
  • Dexamethasone intravitreal implant
  • Diabetic retinopathy

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