Intravitreal Pharmacotherapies for Diabetic Macular Edema

Abstract

To review the evidence on the safety and efficacy of current anti-vascular endothelial growth factor (VEGF) and intravitreal corticosteroid pharmacotherapies for the treatment of diabetic macular edema (DME).Methods: Literature searches were last conducted on May 13, 2020, in the PubMed database with no date restrictions and limited to articles published in English. The combined searches yielded 230 citations, of which 108 were reviewed in full text. Of these, 31 were deemed appropriate for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist.Results: Only the 21 articles with level I evidence were included in this assessment. Seventeen articles provided level I evidence for 1 or more anti-VEGF pharmacotherapies, including ranibizumab (14), aflibercept (5), and bevacizumab (2) alone or in combination with other treatments for DME. Level I evidence was identified in 7 articles on intravitreal corticosteroid therapy for treatment of DME: triamcinolone (1), dexamethasone (4), and fluocinolone acetonide (2).Conclusions: Review of the available literature indicates that intravitreal injections of anti-VEGF agents and corticosteroids are efficacious treatments for DME. Elevated intraocular pressure and cataract progression are important potential complications of corticosteroid therapy. Further evidence is required to assess the comparative efficacy of these therapies. Given the limited high-quality comparative efficacy data, choice of therapy must be individualized for each patient and broad therapeutic access for patients is critical to maximize outcomes. Ophthalmology 2021;-:1e12 ª 2021 by the American Academy of Ophthalmology

Potential Protective Function of Adiponectin in Diabetic Retinopathy

“…The neuroretina's aberrant thickening due to fluid accumulation, frequently accompanied by macular cystoid edema, is the most common cause of vision loss in patients with DR [ 108 ]. Intravitreal injections of corticosteroids and anti-VEGF medications are effective treatments for DME [ 109 ]. One study showed that bevacizumab reduced VEGF and APN concentrations in patients with T2DM, with a corresponding improvement in visual function and no ocular or systemic side effects [ 110 ].…”

Early-switch versus late-switch in patients with diabetic macular edema: a cost-effectiveness study

“…Intravitreal dexamethasone implant (DEX-i) has proven to have a beneficial impact on both anatomic and functional clinical outcomes since it is capable of acting both on inflammatory and on vasogenic mediators [ 16 – 18 ]. Additionally, patients who did not adequately respond to anti‐VEGF treatment should be switched to DEX-i as soon as possible, and preferably after 3 doses of anti-VEGF [ 19 , 20 ].…”

Long-term dynamic changes and influencing factors of corneal morphology after multiple intravitreal injections of anti-VEGF drugs

“…[11] Elevated levels of VEGF detected in the vitreous have been identified as the primary cause of cystic macular edema caused by DME and RVO, hence Ranibizumab and Aflibercept are also widely used in DME and RVO. [12,13] Corneal endothelial cells are hexagonal, and their Na-K pump can effectively maintain the transparency of the cornea. [14] The regenerative capacity of corneal endothelial cells is extremely limited and they cannot be regenerated once damaged, but can be potentially replaced by expansion of surrounding normal endothelial cells, fusion between cells, or rare cell division.…”