Abstract
Diabetes is the most common cause of blindness in working age adults in developed countries. The last decade has seen major advances in the management of diabetic macular edema (DME), with the emergence of numerous therapeutic alternatives whose role is not yet fully defined. In this context, we present an updated review and guide to the clinical management of DME. In this review we discuss the role of complementary studies suggesting different courses of action based on the clinical, angiographic and tomographic classification of DME, and we highlight the role of laser therapy in the treatment of focal and multifocal macular edema. In cases of resistant or diffuse DME with central involvement, we propose the combined use of antiangiogenic drugs or intravitreal corticosteroids followed by laser. In patients with DME with a tractional component and functional repercussion, a surgical approach may be indicated.
Highlights
We are currently facing a world-wide “diabetes epidemic”, with the number of diabetics expected to reach 300 million in 2025 [1]
25% of people with diabetes mellitus have some degree of diabetic retinopathy (DR) and 2-10% has diabetic macular edema (DME) [3]. The incidence of both conditions increases with the duration of diabetes so that after 15 years duration 15% of diabetics have DME and after 20 years more than 90% showed some degree of DR [4]
What does seem clear is that the use of laser therapy in combination with anti-VEGF treatment significantly reduces the number of annual antiVEGF injections needed to treat DME
Summary
We are currently facing a world-wide “diabetes epidemic”, with the number of diabetics expected to reach 300 million in 2025 [1]. Anti-VEGF drugs are administered intravitreally and repeatedly; in a chronic disease like diabetes this is a major drawback, in parallel, investigators are evaluating the possibility of combining anti-VEGF with laser treatment to improve results. In this situation of change and uncertainty it is necessary to establish uniform criteria, based on an extensive review of the literature, as guidance in dealing with this complication, pending the conclusion of these studies and until we have new guidelines on treatment to improve the prognosis of these patients. The results of optical coherence tomography (OCT) and fluorescein angiography (FA) are critical for therapeutic decision-making
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