REVIEW  EMERGING ISSUES ON DIABETIC RETINOPATHY AND DIABETIC MACULAR EDEMA 

Minerva Oftalmologica 2018 June;60(2):53-70

DOI: 10.23736/S0026-4903.18.01793-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Treatment of diabetic macular edema

Rosangela LATTANZIO ✉, Luigi CAPONE, Francesco BANDELLO

Department of Ophthalmology, San Raffaele Hospital Scientific Institute, Vita-Salute University, Milan, Italy

Diabetic macular edema (DME) is the most common manifestation of diabetic retinopathy (DR) leading to visual loss in diabetic patients. DME is a multifactorial disease in which hyperglycemia stirs up proinflammatory and pro-angiogenic cascades leading to vascular abnormalities, breakdown of the blood-retinal barrier and, finally, to intra- or sub-retinal edema. Grid and focal laser photocoagulation, according to the ETDRS recommendations, have been considered for decades the DME standard of care. With the advent of the new intravitreal pharmacotherapies, such as steroids and anti-vascular endothelium growth factor (VEGF) agents, a new scenario has been opened in the management of this complex disease. The main advantage of the intravitreal injections compared to laser procedure is the chance not only to prevent the visual decline but also to promote a visual recovery. Nevertheless, this approach, requiring repeated interventions might amplify the procedure-related adverse effects. Thus, in order to improve the patient’s response and reduce the frequency of controls and re-treatments, several investigations have tried to demonstrate the role of the combination therapy and validated the advantages of long-lasting drug delivery systems. In order to improve the therapeutic strategy of DME, the research is focused on new ocular agents; but, even if there are several different treatment options and regimens, it could be not easy to choose the best correct management, which depends on the clinical pattern of the diabetic maculopathy.

KEY WORDS: Macular edema - Optical coherence tomography - Intravitreal injections - Steroids - Drug delivery systems