DME Management – Current Perspective and Therapeutic Strategies

Document Type : Review Articles

Authors

FRCS, DNB; Professor & Head, Vitreo-Retinal Service, Aravind Eye Hospital, Chennai, India

Abstract

Diabetic Retinopathy (DR) is the premier cause of blindness world over and is the leading ocular complication of diabetes. Visual morbidity in diabetic retinopathy is largely because of Diabetic Macular Edema (DME), although the tractional and hemorrhagic issues of proliferative diabetic retinopathy (PDR) are the more debilitating. There has been a paradigm shift in the gold standard of therapy from macular laser photocoagulation to the current era of anti-Vascular endothelial growth factor therapy (anti-VEGF). The three anti-VEGF injections in vogue are ranibizumab, bevacizumab and aflibercept. Several trials have provided critical information on their safety, efficacy and their dosage as well as dosing regimens. Steroid injections and depot formulations remain in the therapeutic armamentarium, despite their cataractogenic and intraocular pressure elevating side effects. The repetitive nature of the injections and the fact that there still remains a significant quanta of patients that are non-responsive or refractory in time to the anti-VEGF injections, has fuelled continued research for newer therapeutic alternatives.

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