Forming a Consensus: Data and Guidance for Physicians Treating Diabetic Macular Edema.
The diabetic macular edema (DME) treatment paradigm has evolved as the understanding of the disease pathology has grown. Since 2012, four pharmacotherapies have been approved by the U.S. Food and Drug Administration for the treatment of DME. First-line treatment of DME with anti-vascular endothelial growth factor [VEGF] agents has become the gold standard; however, an appreciable percentage of patients do not respond to anti-VEGF therapies. In patients who inadequately respond to anti-VEGF therapies, the underlying disease pathology may be mediated by a multitude of growth factors and inflammatory cytokines. For these patients, corticosteroids are an attractive treatment option because they not only downregulate VEGF, but also an array of cytokines. The phase 3 MEAD and FAME trials demonstrated significant visual acuity improvements associated with dexamethasone and fluocinolone acetonide, respectively, in patients with DME; however, class-specific adverse events, including increased intraocular pressure and cataract development, must be considered before use. A panel of experts gathered during the 2015 annual meeting of the American Academy of Ophthalmology for a roundtable discussion focused on patient selection and adverse event management associated with the use of the 0.19 mg fluocinolone acetonide intravitreal implant.
Carmen A
CA
Puliafito
Scott W
SW
Cousins
Jason
J
Bacharach
Victor H
VH
Gonzalez
Nancy M
NM
Holekamp
Pauline T
PT
Merrill
Matthew P
MP
Ohr
Richard K
RK
Parrish
Christopher D
CD
Riemann
D000047:Academies and Institutes; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D003930:Diabetic Retinopathy / Q000188:drug therapy* / Q000503:physiopathology; D004343:Drug Implants; D005446:Fluocinolone Acetonide / Q000008:administration & dosage* / Q000009:adverse effects; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D058449:Intravitreal Injections; D008269:Macular Edema / Q000188:drug therapy* / Q000503:physiopathology; D009885:Ophthalmology / Q000458:organization & administration; D014481:United States; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014822:Vitreous Body
D020533:Angiogenesis Inhibitors; D004343:Drug Implants; D005938:Glucocorticoids; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D005446:Fluocinolone Acetonide