Modern principles of the diabetic macular edema management

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Abstract

Diabetes mellitus and diabetic retinal lesions are a global challenge for healthcare systems and one of the leading causes of severe vision loss among the working age population. Retinal laser coagulation remained the standard of therapy and the only possible treatment for diabetic macular edema (DME) in the 80-90s of the last century. The introduction of anti-VEGF therapy and glucocorticoids into the wide practice has significantly expanded the range of possibilities of DME treatment, allowing not only to stabilize patients’ vision, but also to improve it. The analyses of the large randomized clinical trials results are made and presented in this article, that highlight the basic principles of the contemporary DME treatment. This information is intended to help the ophthalmologist to develop the most optimal approach to treatment, considering the individual characteristics of each patient and the “evidence-based” efficacy and safety data of different methods.

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About the authors

Natalya K. Mazurina

Posterior eye segment diagnostic and surgery center

Author for correspondence.
Email: mazuraforever@mail.ru
ORCID iD: 0000-0002-5499-1773

PhD, Head of Laserphotocoagulation and Fluorescein Angiography Unit, Deputy Director

Russian Federation, Moscow

Georgiy E. Stolyarenko

Posterior eye segment diagnostic and surgery center

Email: retina@retina.ru

PhD, Professor, Vitreoretinal Surgeon, CEO

Russian Federation, Moscow

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2. Fig. 1. VIVID/VISTA (148 weeks follow-up): A – mean change in best-corrected visual acuity (BCVA) ETDRS letters; B – mean change in central subfield thickness (CST). a In “2q8” group intravitreal aflibercept injections (IAI) were performed every 8 weeks after first 5 monthly injections (n = 135 in VIVID, n = 151 in VISTA). b “Laser” group included cases that were receiving intravitreal aflibercept injections (IAI) in “as needed” regimen (pro re nata, PRN) during the 3rd year (n = 132 in VIVID, in VISTA n = 154). Results obtained after “rescue therapy” were not considered in both groups. *p < 0.0001 **p < 0.0,0001

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3. Fig. 2. VIVID/VISTA. Proportion of patients with ≥2-step DR (diabetic retinopathy) improvement in DRSS score (26–28). а In “2q8” group aflibercept intravitreal aflibercept injections were performed every 8 weeks after first 5 monthly injections (n = 135 in VIVID, n = 151 in VISTA). b “Laser” group included cases that were receiving intravitreal aflibercept injections (IAI) in “as needed” regimen (pro re nata, PRN) during the 3rd year (n = 132 in VIVID, in VISTA n = 154). Results obtained after “rescue therapy” were not considered in both groups. *p < 0.01 in VIVID, *p < 0.001 in VISTA, **p < 0.0001 in both studies, ***p < 0.0001 in VIVID, p < 0.052 in VISTA

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4. Fig. 3. Protocol T DRCR net. (2 years follow-up): A – Mean change in central subfield thickness (CST) in aflibercept and ranibizumab groups in patients with baseline visual acuity 20/32–20/40; B — mean change in best-corrected visual acuity (BCVA) in cohort with baseline visual acuity of 20/32 to 20/40. Number of eyes was 195–244 in aflibercept group and 188–218 in ranibizumab group at different points of follow-up

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5. Fig. 4. Protocol T DRCR net. (2 years follow-up). Mean change in best-corrected visual acuity (BCVA) in cohort with baseline visual acuity 20/50 or worse. Number of eyes was 195–244 in aflibercept group and 188–218 in ranibizumab group at different points of follow-up

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Copyright (c) 2020 Mazurina N.K., Stolyarenko G.E.

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