title: Diabetic Macular Edema: Options for Adjunct Therapy.
abstract: 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.
authors.affiliation: Department of Ophthalmology, Miguel Servet University Hospital, Aragon Health Science Institute, IIS Aragon, Isabel la Católica 1-3, 50009, Zaragoza, Spain, xenatrance@yahoo.es.
authors.forename: Pilar
authors.initials: P
authors.lastname: Calvo
authors.forename: Beatriz
authors.initials: B
authors.lastname: Abadia
authors.forename: Antonio
authors.initials: A
authors.lastname: Ferreras
authors.forename: Oscar
authors.initials: O
authors.lastname: Ruiz-Moreno
authors.forename: Guayente
authors.initials: G
authors.lastname: Verdes
authors.forename: Luis E
authors.initials: LE
authors.lastname: Pablo
mesh_terms: D020533:Angiogenesis Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D003930:Diabetic Retinopathy / Q000188:drug therapy* / Q000209:etiology; D018450:Disease Progression; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008269:Macular Edema / Q000188:drug therapy* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D000069579:Ranibizumab / Q000494:pharmacology / Q000627:therapeutic use*; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D005938:Glucocorticoids; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab