Targeting the Pathophysiology of Diabetic Macular Edema

Romero-Aroca, Pedro

doi:10.2337/dc10-1580

Cited by 58 publications

(47 citation statements)

References 7 publications

(7 reference statements)

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“…Diabetic macular edema (DME), a complex disease of multifactorial origin, is the leading cause of blindness in the diabetic population [1]. Clinically significant macular edema, as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS), includes any one of the following lesions: retinal thickening at or within 500 microns from the center of the macular; hard exudates at or within 500 microns from the center of the macular associated with thickening of the adjacent retina; an area or areas of retinal thickening at least 1 disk area in size, at least part of which is within 1 disk diameter of the center of the macular [2].…”

Section: Introductionmentioning

confidence: 99%

“…Clinically significant macular edema, as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS), includes any one of the following lesions: retinal thickening at or within 500 microns from the center of the macular; hard exudates at or within 500 microns from the center of the macular associated with thickening of the adjacent retina; an area or areas of retinal thickening at least 1 disk area in size, at least part of which is within 1 disk diameter of the center of the macular [2]. The common pathway that results in DME is disruption of the blood-retinal barrier [1]. As macular edema (ME) develops, blurring occurs in the middle or to the side of the central visual field.…”

Section: Introductionmentioning

confidence: 99%

“…Findings from the Diabetes Control and Complications Trial (DCCT) study [5] reported that 27% of type 1 diabetic patients developed DME within 9 years of diabetes onset [1]. …”

Section: Introductionmentioning

confidence: 99%

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Prevalence, Demographics, and Treatment Characteristics of Visual Impairment due to Diabetic Macular Edema in a Representative Canadian Cohort

Petrella

Blouin

Davies

et al. 2012

Journal of Ophthalmology

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Diabetic macular edema (DME) is the leading cause of blindness in the diabetic population. However, there is limited understanding of the epidemiology of DME with visual impairment (VI) and treatment in patients with diabetes in Canada. This observational, retrospective study used records from the Southwestern Ontario database to observe the demographics, prevalence, and treatment characteristics of VI due to DME compared to a healthy population in a real-world Canadian setting. Data was compared between a cohort of 8,368 diabetic (type 1 or 2) patients, who were ≥18 years old and had a diagnosis of DME with VI (visual acuity <20/40 in Snellen equivalent), and 76,077 age- and gender-matched subjects representing a healthy population. Among diabetic patients, prevalence of DME was 15.7%, and prevalence of VI due to DME was 2.56%. Laser monotherapy was the most frequently used treatment. Public funding covered costs for 85% of persons with DME while 18% were paid for with private funds. This study provides insight into the demographics, prevalence, and treatment of VI due to DME in a representative Canadian cohort. This data can help to inform evaluation of current DME treatment patterns and of proposed new treatment on drug plan budgets in Canada.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence, Demographics, and Treatment Characteristics of Visual Impairment due to Diabetic Macular Edema in a Representative Canadian Cohort

Petrella

Blouin

Davies

et al. 2012

Journal of Ophthalmology

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“…VEGF-A induces the phosphorylation of proteins such as occludin and zonula occludens-1, opening intercellular junctions and inducing fenestrations and vacuolization, thus increasing paracellular and transcellular permeability. VEGF also induces apoptosis of pericytes, astrocytes, and neurons [16].…”

Section: Pathophysiology Of Diabetic Retinopathymentioning

confidence: 99%

Diabetic Macular Edema: Options for Adjunct Therapy

Calvo

Abadia

Ferreras

et al. 2015

Drugs

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Diabetes mellitus (DM) is a chronic disease that affects 387 million people worldwide. Diabetic retinopathy (DR), a common complication of DM, is the main cause of blindness in the active population. Diabetic macular edema (DME) may occur at any stage of DR, and is characterized by vascular hyperpermeability accompanied by hard exudates within the macula. Medical and surgical therapies have dramatically reduced the progression of DR, and timely intervention can reduce the risk of severe vision loss by more than 90 %. In 2012, intravitreal ranibizumab became the first antivascular endothelial growth factor (anti-VEGF) agent approved for DME and, since then, many reports of the use of ranibizumab for DME have been promising. Randomized, prospective, multicenter clinical trials-most notably, RESOLVE, READ-2, RISE/RIDE, RESTORE, DRCR.net protocol I, and RETAIN-reported improvements in best-corrected visual acuity and decreased central retinal thickness as measured with optical coherence tomography in patients with DME. Similar treatment benefits have also been noted in clinical trials evaluating intravitreal aflibercept and bevacizumab (DAVINCI, VISTA/VIVID, and BOLT) and more recently DRCR.net protocol T. Intravitreal steroids (dexamethasone intravitreal implant and fluocinolone acetonide), particularly in refractory cases, also play a significant role in the management of DME (MEAD/CHAMPLAIN and FAMOUS/FAME studies). In summary, over the last 5 years, blocking VEGF and inflammation has been shown to improve visual outcomes in patients with macular edema due to DM, revolutionizing the treatment of center-involved DME and establishing a new standard of care.

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“…During DME, permeability through retinal barriers increases, causing protein leakage within the interstitial retinal tissue that will be accompanied by water accumulation (Romero-Aroca, 2010). This vasogenic edema may be accompanied by an increase in intracellular fluid volume (cell swelling) (Kohno et al, 1983; Yanoff et al, 1984).…”

Section: Introductionmentioning

confidence: 99%