Diabetic macular edema: Evidence-based management

Diabetic macular edema (DME) is the most common cause of vision loss in patients with diabetic retinopathy with an increasing prevalence tied to the global epidemic in type 2 diabetes mellitus. Its pathophysiology starts with decreased retinal oxygen tension that manifests as retinal capillary hyper...

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Bibliographic Details
Published in:Indian journal of ophthalmology 2018-12, Vol.66 (12), p.1736-1750
Main Authors: Browning, David, Stewart, Michael, Lee, Chong
Format: Article
Language:English
Subjects:
Angiogenesis Inhibitors - administration & dosage
Angiography
Blood pressure
Clinical trials
Corticosteroids
Cytokines
Diabetes
Diabetes mellitus
Diabetes mellitus (non-insulin dependent)
Diabetic retinopathy
Diabetic Retinopathy - complications
Diabetic Retinopathy - diagnosis
Diabetic Retinopathy - therapy
Disease Management
Edema
Fluorescein Angiography
Fundus Oculi
Hemoglobin
Homeostasis
Humans
Hyperglycemia
Intravitreal Injections
Laser Coagulation - methods
macular edema
Macular Edema - diagnosis
Macular Edema - etiology
Macular Edema - therapy
Medical imaging
Ophthalmology
Oxygen tension
Permeability
Retina
Retinopathy
Review
Social organization
Tomography, Optical Coherence
Vascular endothelial growth factor
Vascular Endothelial Growth Factor A - antagonists & inhibitors
Visual Acuity
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Summary:Diabetic macular edema (DME) is the most common cause of vision loss in patients with diabetic retinopathy with an increasing prevalence tied to the global epidemic in type 2 diabetes mellitus. Its pathophysiology starts with decreased retinal oxygen tension that manifests as retinal capillary hyperpermeability and increased intravascular pressure mediated by vascular endothelial growth factor (VEGF) upregulation and retinal vascular autoregulation, respectively. Spectral domain optical coherence tomography (SD-OCT) is the cornerstone of clinical assessment of DME. The foundation of treatment is metabolic control of hyperglycemia and blood pressure. Specific ophthalmic treatments include intravitreal anti-VEGF drug injections, intravitreal corticosteroid injections, focal laser photocoagulation, and vitrectomy, but a substantial fraction of eyes respond incompletely to all of these modalities resulting in visual loss and disordered retinal structure and vasculature visible on SD-OCT and OCT angiography. Efforts to close the gap between the results of interventions within randomized clinical trials and in real-world contexts, and to reduce the cost of care increasingly occupy innovation in the social organization of ophthalmic care of DME. Pharmacologic research is exploring other biochemical pathways involved in retinal vascular homeostasis that may provide new points of intervention effective in those cases unresponsive to current treatments.
ISSN:0301-4738
1998-3689
DOI:10.4103/ijo.IJO_1240_18