Abstract
Macular edema (ME) is a major complication of several vascular and inflammatory retinal diseases. Multiple mechanisms are implicated in its development and lead to visual impairment that could be reversible (the acute stages) or not reversible (long-standing ME). For this reason, an effective approach to the treatment of ME is of paramount importance in order to prevent irreversible damage of visual function. In this review, we discuss the management of ME and, in particular, current data of studies and clinical trials about drugs that have already been evaluated or are under investigation in the management of ME. Although several diseases could lead to the development of ME, we focus on the three main causes: diabetic retinopathy (DR), retinal vein occlusion (RVO), and uveitis. The introduction into clinical practice of anti-vascular endothelial growth factor injections (ranibizumab and aflibercept) and dexamethasone implants has revolutionized the treatment of ME secondary to DR and RVO. However, new drugs are needed in the treatment of resistant forms of ME secondary to DR and RVO. A fluocinolone acetonide implant has been approved by the US Food and Drug Administration for the treatment of diabetic ME but not for RVO. Furthermore, brolucizumab and abicipar pegol have been shown to be effective in preliminary studies and have the chance to be approved soon for diabetic ME treatment. In ME secondary to uveitis, a crucial role is played by corticosteroids and non-biologic immunomodulatory drugs. However, several new biologic agents are under investigation in different clinical trials and could be important new therapeutic options in cases with a low response to first-line therapy. However, only a few of these drugs will enter the market after proving their safety and efficacy. Only after that will we be able to offer a new therapeutic option to patients affected by uveitic ME.
Highlights
Macular edema (ME) is the major cause of visual impairment in several metabolic, vascular, and inflammatory retinal diseases
We focus on the management of ME and, in particular, on current data of studies and clinical trials about drugs that are under investigation or have already been evaluated in ME management
ME is a major complication of several vascular and inflammatory retinal diseases and multiple mechanisms are implicated in its development
Summary
Macular edema (ME) is the major cause of visual impairment in several metabolic, vascular, and inflammatory retinal diseases. Since its approval in China in 2013, conbercept has been used there for the treatment of neovascular age-related macular degeneration and other retinal vascular diseases, including DME51,52 It has not yet reached the market in other countries, given its excellent safety and efficacy profile, it has gained worldwide attention as a promising option. Intravitreal corticosteroid agents, such as triamcinolone and dexamethasone implant, have been evaluated[67] and are currently considered valid therapeutic options in RVO treatment because of their anti-inflammatory, anti-angiogenic, and anti-edema properties They are able to improve visual acuity in the short term and have proven especially useful in pseudophakic patients or patients who do not experience significant intraocular pressure elevation with local steroid use. Many other molecules—such as abatacept (Orencia®, BristolMyers Squibb Company, New York, NY, USA), a T-lymphocyte inhibitor; gevokizumab (XOMA 052, XOMA Corporation, Berkeley, CA, USA), an anti-IL-1β; ustekinumab (Stelara, Janssen-Cilag International NV, Beerse, Belgium), an anti-IL-12 and anti-IL-23; and filgotinib (GLPG0634), a janus kinase 1— are under investigation in different phase 2 clinical trials with promising results[114,115,116,117,118,119,120]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
