Anti-VEGF for the management of diabetic macular edema.

Francisco Rosa Stefanini,Michel Eid Farah,Michael Koss,Emmerson Badaró,Maurício Maia,Paulo Falabella

doi:10.1155/2014/632307

Abstract

Diabetic retinopathy (DR) is an important cause of vision loss around the world, being the leading cause in the population between 20 and 60 years old. Among patients with DR, diabetic macular edema (DME) is the most frequent cause of vision impairment and represents a significant public health issue. Macular photocoagulation has been the standard treatment for this condition reducing the risk of moderate visual loss by approximately 50%. The role of vascular endothelial growth factor (VEGF) in DR and DME pathogenesis has been demonstrated in recent studies. This review addresses and summarizes data from the clinical trials that investigated anti-VEGF for the management of DME and evaluates their impact on clinical practice. The literature searches were conducted between August and October 2013 in PubMed and Cochrane Library with no date restrictions and went through the most relevant studies on pegaptanib, ranibizumab, bevacizumab, and aflibercept for the management of DME. The efficacy and safety of intravitreal anti-VEGF as therapy for DME have recently been proved by various clinical trials providing significantly positive visual and anatomical results. Regarding clinical practice, those outcomes have placed intravitreal injection of anti-VEGF as an option that must be considered for the treatment of DME.

Highlights

Obesity is a major risk factor for type 2 diabetes and has increased in prevalence in the last decades [1, 2]
On the basis of evidence that vascular endothelial growth factor (VEGF) expression and signaling are deregulated in diabetic retinopathy, anti-VEGF compounds have been studied as a pharmacological alternative treatment for Diabetic macular edema (DME)
Pegaptanib sodium is a selective VEGF antagonist that binds with the 165 isoform of VEGF and was approved by the US Food and Drug Administration (FDA) for the treatment of neovascular age-related macular disease (AMD) [22]

Summary

Introduction

Obesity is a major risk factor for type 2 diabetes and has increased in prevalence in the last decades [1, 2]. Diabetic retinopathy (DR) is a leading cause of vision loss in workingage patients around the world. Diabetic macular edema (DME) is primarily responsible for vision impairment in diabetic patients [5,6,7] (Figure 1). A large epidemiological study indicated that 26% of patients with diabetic retinopathy presented with DME [8]. The prevalence of macular edema in patients with recently diagnosed diabetes is 0 to 3%, increasing to 29% in diabetic patients with over 20 years of disease [9]. Ophthalmic complications of the diabetes, especially DME, represent a significant public health issue (Figure 2)

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Conclusion