Treatment strategies for refractory diabetic macular edema: switching anti-VEGF treatments, adopting corticosteroid-based treatments, and combination therapy

Abstract

Introduction: The pathophysiology of diabetic macular edema (DME) is complex, involving vascular endothelial growth factor (VEGF) and other inflammatory mediators.

Sequential Dexamethasone and Aflibercept Treatment in Patients with Diabetic Macular Edema: Structural and Functional Outcomes at 52 Weeks

“…Intravitreal therapies with anti-VEGF, corticosteroids or the combination of both are presented as therapeutic options in the DME treatment, granting benefits to the functional and anatomical recovery when compared to the natural progression of the disease or to the focal laser treatment [12]. Both treatments are well tolerated and improved BCVA and anatomic outcomes in patients with DME [13].…”

Identification of time point to best define ‘sub-optimal response’ following intravitreal ranibizumab therapy for diabetic macular edema based on real-life data

“…Furthermore, there are few clinical trials on the role of switching from anti-VEGF to steroid therapy or addition of steroid therapy to on-going anti-VEGF therapy in DME. 22 Both the OZLASE and OZDRY studies included patients with long-standing and persistent edema despite previous laser and/or anti-VEGF therapy. 23,24 These studies did not show any visual benefit despite resolution of fluid at the end of the follow-up, using intravitreal dexamethasone implant (Ozurdex, Irvine, CA, USA).…”

Three-month outcome of intravitreal ziv-aflibercept in eyes with diabetic macular oedema

“…Currently, bevacizumab is the most cost-effective medication for control of DME21 compared with ranibizumab (40 times less expensive) or aflibercept 18 20 22. The actual compounded cost is 60 times less for ziv-aflibercept than for aflibercept, if the 4 mL ziv-aflibercept phial is divided into 40 aliquots (4 mL Zaltrap 25 mg/mL phial costs US$536 while single Eylea phial costs US$1200 in Lebanon).…”