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Treatment of diabetic macular edema

Diabetologe, ISSN: 1860-9724, Vol: 14, Issue: 8, Page: 577-589
2018
  • 5
    Citations
  • 0
    Usage
  • 24
    Captures
  • 0
    Mentions
  • 0
    Social Media
Metric Options:   Counts1 Year3 Year

Metrics Details

  • Citations
    5
    • Citation Indexes
      5
  • Captures
    24

Article Description

Background: Diabetic macular edema (DME) is a common cause of diabetes-related visual impairment that also affects patients of working age. Laser treatment has been the gold standard of DME treatment for decades. The introduction of intravitreal injection therapies, e. g. anti-VEGF therapy, has widened the range of treatment options. This allows more individualized DME therapy and improves the prognosis for vision. Objectives: This article aims to provide a short overview of current therapy options and their relevance in DME treatment based on recent studies and treatment recommendations. Results: VEGF-Inhibitors represent a first-line treatment and are superior to laser treatment when DME affects the fovea. In addition to ranibizumab and aflibercept, bevacizumab is used off-label. High treatment frequencies with an average of seven to nine injections in the 1st year and monthly controls, if possible using optical coherence tomography, are crucial. The number of injections required decreases thereafter. The gain in visual acuity of on average two to three lines demonstrated in studies is usually not achieved in real life due to under-treatment. Intravitreal steroids provide longer treatment effects, but are second choice due to local side effects, mainly cataract and glaucoma. Laser therapy remains an option (1st choice in extrafoveal DME). In special cases, vitrectomy may be indicated. Conclusions: Modern DME treatment permits individualized therapies based on multimodal diagnostics while taking the patient’s individual situation and wishes into account. However, in order to make effective use of these opportunities , early diagnosis (screening), adequate patient motivation, and appropriate risk factor adjustment are required.

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