Treatment of diabetic macular oedema

Czech version

Authors: J. Ernest
Authors‘ workplace: Oční klinika 1. lékařské fakulty UK a ÚVN Praha, přednosta doc. MUDr. Jiří Pašta, CSc., FEBO
Published in: Vnitř Lék 2013; 59(3): 194-200
Category: Reviews

Overview

Diabetic macular oedema (DMO) is currently the main complication associated with diabetes. The percentage of patients with DMO grows alongside the increasing number of diabetes occurrences. The DMO treatment has seen major developments in the past few years. A number of new treatment technologies have emerged, which enable not only a stabilisation of macular oedema but in the case of an early detection also a decrease of retina oedema accompanied by a visual functions improvement. Laser coagulation has remained the standard DMO treatment for many years; when applying modern diagnostic testing technologies (FAG and OCT), the newest trend in DMO treatment is the use of anti-VEGF preparations, depot intravitreal corticoids and in some cases also surgical intervention in the form of pars plana vitrectomy (PPV). The DMO treatment algorithm is presented in this paper.

Key words:
diabetic macular oedema (DMO/DME) – anti-VEGF – pars plana vitrectomy (PPV) – depot corticoids – laser coagulation

Sources

1. Boyer DS, Faber D, Gupta S et al. Ozurdex CHAMPLAIN Study Group. Dexamethazon intravitreal implant for treatment of diabetic macular edema in vitrectomized pacients. Retina 2011: 4 (Epub ahead of print).

2. DRCR Network, Browning DJ, Glassman AR et al. Relationship between optical coherence tomography-measured central retinal thickness and visual acuity in diabetic macular edema. Opthalmology 2007; 114: 525–536.

3. DRCR Network. Factors asscociated with visual acuity outcomes after vitrectomy for diabetic macular edema. Retina 2010; 30: 1488–1495.

4. Early Treatment Diabetic Retinopathy Study Research Group. Treatment techniques and clinical quidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report No. 2. Opthalmology 1987; 94: 761–774.

5. Figuera J, Khan J, Nunes N et al. Prospective randomized controlled trial comparing sub--threshold diode laser photocoagulation and conventional green laser for clinically significant macula edema. Br J Opthalmol 2009; 93: 1341–1344.

6. Hikichi T, Fujio N, Akiba J et al. Association between the short-term natural history of diabetic macular edema and vitreomacular relationship in the II diabetes mellitus. Opthalmology 1997; 104: 473–478.

7. Chew EY, Klein ML, Ferris FL et al. Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy. Early Treatment Diabetic Retinopathy Study (ETDRS) Report 22. Arch Opthalmol 1996; 114: 1079–1084.

8. Kampik A. Vitrectomy a viable option in select DME cases. Ocular surgery news 2012; 2: 22.

9. Murphy R. Therapeutic triangulation: The DME treatment revolution. Retinal physician 2012; 4: 54–57.

10. Nasrallah FP, Jalkh EA, Van Copenolle F et al. The role of the vitreous in diabetic macular edema. Opthalmology 1988; 95: 1335–1339.

11. Nguyen QD, Brown DM, Marcus DM et al. Ranibizumab for diabetic macular edema: result from 2 phase III randomized trials: RISE and RIDE. Opthalmology 2012; 119: 1064–1073.

12. Park JH, Woo SJ, Ho YJ et al. Effect of vitrectomy on microcirculation in patients with diffuse macular edema. Graefes Arch Clin Exp Opthalmol 2009; 217: 1009–1017.

13. The READ-2 Study Group. Two-year outcomes of ranibizumab for edema of the macula in diabetes (READ-2) study. Opthalmology 2010; 117: 2146–2151.

14. The RESTORE Study Group. Ranibizumab monoteraphy or combined with laser monotherapy for diabetic macular edema. Opthalmology 2011; 118: 615–625.

15. UK Prospective Study Group. UKPDS38. Tight blood pressure control and risk of macrovascular and microvascular complication in type 2 diabetes mellitus. BMJ 1998; 317: 703–713.

16.Virgil G, Manchini F, Diamastrogiovanni AF et al. Optical coherence tomography versus stereoscopic fundus photography or biomicroscophy for diagnostic macular edema. Inv. Opthalmol Vis Sci 2007; 48: 4963–4973.

17. Vujosevic S, Bottega E, Casciano M et al. Microperimetry and fundus autofluorescence in diabetic macular edema: subthreshold micropulse diode laser versus modified early treatment diabetic retinopathy study laser photocoagulation. Retina 2010; 30: 908–916.