Is Laser Still Important in Diabetic Macular Edema as Primary or Deferral Therapy

Parodi, Maurizio Battaglia; Bandello, Francesco

doi:10.1159/000459696

Cited by 6 publications

(2 citation statements)

References 9 publications

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“…During pregnancy, the first-line therapy should be glucose control and laser photocoagulation. However, in severe cases of DME, the DEX implant could be an option, but it has to be offered only in the second/third trimesters and carefully discussed with the patient [41,[45][46][47]. Moreover, it can also be recommended in vitrectomized, pseudophakic, or chronic DME patients.…”

Section: Guidelines From the Emirates Experts [28]mentioning

confidence: 99%

Intravitreal DEX Implant for the Treatment of Diabetic Macular Edema: A Review of National Consensus

Spinetta,

Petrillo,

Reibaldi

et al. 2023

Pharmaceutics

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Diabetic macular edema (DME)’s therapeutic approach can frequently be challenging. The purpose of the review is to propose evidence-based recommendations on the employment of intravitreal dexamethasone implants (DEX) when approaching patients suffering from DME. Seven national consensuses redacted by different groups of retina specialists from Europe and Asia were examined and confronted. Each consensus was redacted utilizing a Delphi approach, in person meetings, or by reviewing the literature. DEX can be studied as a first-line strategy in individuals suffering from DME with inflammatory OCT biomarkers, in vitrectomized eyes, in patients with recent cardiovascular events, in pregnant women, in patients scheduled to undergo cataract surgery or with poor compliance. The other parameters considered were the indications to the DME treatment, when to switch to DEX, the definition of non-responder to anti-VEGFs agents and to the DEX implant, whether to combine DEX with laser photocoagulation, the association between glaucoma and DEX, and the management of DEX and the cataract. Although several years have passed since the introduction of DEX implants in the DME treatment, there is still not a unified agreement among retina specialists. This paper compares the approach in the DME treatment between countries from different continents and provides a broader and worldwide perspective of the topic.

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Section: Guidelines From the Emirates Experts [28]mentioning

confidence: 99%

Intravitreal DEX Implant for the Treatment of Diabetic Macular Edema: A Review of National Consensus

Spinetta,

Petrillo,

Reibaldi

et al. 2023

Pharmaceutics

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show abstract

“…[ 3 ] At present, the treatment of DME includes laser therapy, intravitreal corticosteroids, intraviral anti-vascular endothelial growth factor (VEGF), and surgical treatments. [ 4 ] Among them, intravitreal injections of anti-VEGF drugs have been the main treatment for DME. It has been confirmed that anti-VEGF drugs can specifically inhibit the expression of VEGF in local tissues and effectively reduce DME by inhibiting the generation and progression of neovascularization and improving the permeability of retinal and choroidal microvessels.…”

Section: Introductionmentioning

confidence: 99%

Optical coherence tomography classifications of diabetic macular edema and response to aflibercept: One-year follow-up outcomes in a Chinese population

Xi²,

Zhang³

et al. 2023

Medicine

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To evaluate the effect of intravitreal aflibercept on different classifications of diabetic macular edema (DME) by spectral-domain optical coherence tomography. This hospital-based retrospective study included 95 consecutive patients (130 eyes) diagnosed with DME. Three groups were defined: diffuse retinal thickening (DRT), cystoid macular edema and serous retinal detachment. All eyes received intravitreal aflibercept (0.05 mL/2 mg) 5 times monthly. Best corrected visual acuity (BCVA) in (logarithm of the minimum angle of resolution) units and central macular thickness (CMT) on optical coherence tomography were recorded at months 1, 2, 3, 4, 6, and 12 after the injections. There was no significant baseline difference in BCVA (P = .273) or CMT (P = .115) among the 3 groups. Over 12 months, the BCVA of the DRT group significantly improved from baseline (P = .013). The BCVA of the cystoid macular edema (P = .062) and serous retinal detachment groups (P = .073) improved slightly from baseline. The DRT group had the greatest BCVA improvement (P = .021). Over 12 months, the CMTs of all 3 groups significantly decreased from baseline (P = .016, P = .025, P = .031). The CMT decreased more in the DRT group than in the other 2 groups (P = .009). The CMT changes were most evident in the DRT group (P = .022). Binary logistic regression analysis showed that DME type, disorganization of the retinal inner layers, ellipsoid zone disruption and external limiting membrane disruption independently predicted the effect of aflibercept treatment in DME patients (P = .006, P = .001, P = .004, P = .001). Aflibercept therapy improved anatomical structure and visual acuity in every type of DME; DRT responded best in terms of both BCVA and CMT. Furthermore, DME, disorganization of the retinal inner layers, external limiting membrane disruption and ellipsoid zone disruption independently predicted the effect of aflibercept treatment in DME patients.

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Lasers in Diabetic Retinopathy

Gawęcki¹,

Luttrull

Grzybowski³

2023

Retina Lasers in Ophthalmology

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Is Laser Still Important in Diabetic Macular Edema as Primary or Deferral Therapy

Cited by 6 publications

References 9 publications

Intravitreal DEX Implant for the Treatment of Diabetic Macular Edema: A Review of National Consensus

Intravitreal DEX Implant for the Treatment of Diabetic Macular Edema: A Review of National Consensus

Optical coherence tomography classifications of diabetic macular edema and response to aflibercept: One-year follow-up outcomes in a Chinese population

Lasers in Diabetic Retinopathy

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