Types Of Diabetic Macular Edema Research Articles

The Responses of Different Types of Diabetic Macular Edema after Three Loading Doses of Anti-vascular Growth Factor: Outcomes in Two Medical Centers

Background: Diabetic macular edema (DME) is currently treated by anti-vascular endothelial growth factor (anti-VEGF). Aim: The aim of this study was to evaluate the effect of intravitreal anti-VEGF in different types of DME classified by optical coherence tomography (OCT). Methods: This retrospective study included 161 treatment-naive eyes (116 patients) diagnosed with DME in two tertiary medical centers, which were classified into three groups according to initial OCT finding: diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). All eyes received three monthly loading doses of anti-VEGF. Primary and secondary outcomes were the improvement of best-corrected visual acuity (BCVA) and the decrease of central foveal thickness (CFT) on OCT, respectively. Results: Among the three groups, there was no significant difference in baseline BCVA (P = 0.137); however, the SRD group had the thickest baseline CFT (P < 0.001). After three loading doses of anti-VEGF, the BCVA of all three groups improved from baseline (DRT vs. CME vs. SRD, P = 0.0002, P < 0.0001, and P < 0.0001, respectively), while the SRD group seemed to have relatively better improvement among three groups although not significant (P = 0.051). The CFTs of all three groups significantly decreased from baseline (P < 0.0001 in all three groups). The CFT decreased the most in the SRD group, followed by the CME group, and the least in the DRT group (P < 0.001). Conclusion: Anti-VEGF therapy improved the anatomical structure and function in all types of DME; SRD responded the best.

Aflibercept or ranibizumab for diabetic macular edema.

Vascular endothelial growth factor (VEGF) is the primary substance involved in retinal barrier breach. VEGF overexpression may cause diabetic macular edema (DME). Laser photocoagulation of the macula is the standard treatment for DME; however, recently, intravitreal anti-VEGF injections have surpassed laser treatment. Our aim was to evaluate the efficacy of intravitreal injections of aflibercept or ranibizumab for managing treatment-naive DME. This single-center, retrospective, interventional, comparative study included eyes with visual impairment due to treatment-naive DME that underwent intravitreal injection of either aflibercept 2 mg/0.05 mL or ranibizumab 0.5 mg/0.05 mL at Al-Azhar University Hospitals, Egypt between March 2023 and January 2024. Demographic data and full ophthalmological examination results at baseline and 1, 3, and 6 months post-injection were collected, including the best-corrected distance visual acuity (BCDVA) in logarithm of the minimum angle of resolution (logMAR) notation, slit-lamp biomicroscopy, dilated fundoscopy, and central subfield thickness (CST) measured using spectral-domain optical coherence tomography. Overall, the 96 eyes of 96 patients with a median (interquartile range [IQR]) age of 57 (10) (range: 20-74) years and a male-to-female ratio of 1:2.7 were allocated to one of two groups with comparable age, sex, diabetes mellitus duration, and presence of other comorbidities (all P >0.05). There was no statistically significant difference in baseline diabetic retinopathy status or DME type between groups (both P >0.05). In both groups, the median (IQR) BCDVA significantly improved from 0.7 (0.8) logMAR at baseline to 0.4 (0.1) logMAR at 6 months post-injection (both P = 0.001), with no statistically significant difference between groups at all follow-up visits (all P >0.05). The median (IQR) CST significantly decreased in the aflibercept group from 347 (166) µm at baseline to 180 (233) µm at 6 months post-injection, and it decreased in the ranibizumab group from 360 (180) µm at baseline to 190 (224) µm at 6 months post-injection (both P = 0.001), with no statistically significant differences between groups at all follow-up visits (all P >0.05). No serious adverse effects were documented in either group. Ranibizumab and aflibercept were equally effective in achieving the desired anatomical and functional results in patients with treatment-naïve DME in short-term follow-up without significant differences in injection counts between both drugs. Larger prospective, randomized, double-blinded trials with longer follow-up periods are needed to confirm our preliminary results.

Convolution neural network model for predicting various lesion-based diseases in diabetic macula edema in optical coherence tomography images

Diabetic Macular Edema (DME), a rare eye disease primarily found in diabetic patients, is due to the formation of fluid in the extra-cellular space of the macular area in the retina. In the earlier days, it was detected through fundus images that provided less accuracy and were difficult for early detection. Optical Coherence Tomography (OCT) is widely adopted to overcome such issues. It is an advanced imaging modality that provides a better view of the retinal structure. However, the medical professionals manually carried out the detection of DME from the OCT images. Advancement in machine learning algorithms has enabled easy processing of OCT images for DME detection. However, the machine learning algorithm provided less accuracy as it was limited to 2-dimensional datasets and their parameters. The lesions in the images were detected using the 3-dimensional structure of the OCT images. The deep learning algorithms consisted of various layers that increased the algorithm's efficiency and provided the necessary features and parameters that helped in the earlier detection of DME. It is also important to detect the types of DME like hemorrhages, Microaneurysms, and exudate. In this paper, a novel lesion-based CNN algorithm is proposed for the efficient detection of the lesions that help in better prediction. The proposed model is compared with other deep learning models, and the results show that the LCNN model provides improved accuracy than normal deep learning models like ResNet, VGG16, and Inception. The accuracy of deep learning models like AlexNet and Inception is increased to 96%.

Macular vascular features of different types of diabetic macular edema using ocular coherence tomography angiography- a comparative study

BackgroundTo compare the microvascular features of different subtypes of diabetic macular edema (DME) by optical coherence tomography angiography (OCTA).MethodsA cross-sectional study including treatment-naive patients with DME. Eyes were divided according to optical coherence tomography determined morphology into two groups: cystoid macular edema (CME) and diffuse retinal thickening (DRT), with further subdivision according to the presence of subretinal fluid. All patients underwent 3 × 3 and 6 × 6 mm OCTA scans of the macula to compare the foveal avascular zone (FAZ) area, vascular density (VD) of the superficial (SCP) and deep (DCP) capillary plexus and choriocapillaris flow (CF). Laboratory findings (HbA1C and triglyceride levels) were also correlated with the OCTA findings.ResultsThe study included 52 eyes, 27 had CME and 25 had DRT. There were no significant differences between the VD of the SCP (p = 0.684) and DCP (p = 0.437), FAZ of SCP (p = 0.574), FAZ of DCP (p = 0.563) and CF (p = 0.311). Linear regression analysis revealed that DME morphology was the strongest predictor for BCVA. Other significant predictors included HbA1C and triglyceride levels.ConclusionThe morphology of DME, irrespective of SRF, was most significantly correlated with BCVA in treatment-naive patients and CME subtype could be an independent predictor of poor BCVA in patients with DME.

Optical coherence tomography classifications of diabetic macular edema and response to aflibercept: One-year follow-up outcomes in a Chinese population.

To evaluate the effect of intravitreal aflibercept on different classifications of diabetic macular edema (DME) by spectral-domain optical coherence tomography. This hospital-based retrospective study included 95 consecutive patients (130 eyes) diagnosed with DME. Three groups were defined: diffuse retinal thickening (DRT), cystoid macular edema and serous retinal detachment. All eyes received intravitreal aflibercept (0.05 mL/2 mg) 5 times monthly. Best corrected visual acuity (BCVA) in (logarithm of the minimum angle of resolution) units and central macular thickness (CMT) on optical coherence tomography were recorded at months 1, 2, 3, 4, 6, and 12 after the injections. There was no significant baseline difference in BCVA (P = .273) or CMT (P = .115) among the 3 groups. Over 12 months, the BCVA of the DRT group significantly improved from baseline (P = .013). The BCVA of the cystoid macular edema (P = .062) and serous retinal detachment groups (P = .073) improved slightly from baseline. The DRT group had the greatest BCVA improvement (P = .021). Over 12 months, the CMTs of all 3 groups significantly decreased from baseline (P = .016, P = .025, P = .031). The CMT decreased more in the DRT group than in the other 2 groups (P = .009). The CMT changes were most evident in the DRT group (P = .022). Binary logistic regression analysis showed that DME type, disorganization of the retinal inner layers, ellipsoid zone disruption and external limiting membrane disruption independently predicted the effect of aflibercept treatment in DME patients (P = .006, P = .001, P = .004, P = .001). Aflibercept therapy improved anatomical structure and visual acuity in every type of DME; DRT responded best in terms of both BCVA and CMT. Furthermore, DME, disorganization of the retinal inner layers, external limiting membrane disruption and ellipsoid zone disruption independently predicted the effect of aflibercept treatment in DME patients.

Multivendor fully automatic uncertainty management approaches for the intuitive representation of DME fluid accumulations in OCT images

Diabetes represents one of the main causes of blindness in developed countries, caused by fluid accumulations in the retinal layers. The clinical literature defines the different types of diabetic macular edema (DME) as cystoid macular edema (CME), diffuse retinal thickening (DRT), and serous retinal detachment (SRD), each with its own clinical relevance. These fluid accumulations do not present defined borders that facilitate segmentational approaches (specially the DRT type, usually not taken into account by the state of the art for this reason) so a diffuse paradigm is used for its detection and visualization. In this paper, we propose three novel approaches for the representation and characterization of these types of DME. A baseline proposal, using a convolutional neural network as backbone, another based on transfer learning from a general domain, and a third approach exploiting information of regions without a defined label. Overall, our baseline proposal obtained an AUC of 0.9583 ± 0.0093, the approach pretrained with a general-domain dataset an AUC of 0.9603 ± 0.0087, and the approach pretrained in the domain taking advantage of uncertainty, an AUC of 0.9619 ± 0.0073.

Real-life outcomes of intravitreal ranibizumab, aflibercept, and dexamethasone implant administrations in patients with treatment-naïve diabetic macular edema.

PURPOSE:To investigate optical coherence tomography (OCT) biomarker data on visual recovery in treatment-naïve diabetic macular edema (DME) and follow the results of intravitreal ranibizumab (RNB), aflibercept (AFL), and dexamethasone (DEX) implant administration within the 1st year of the pro re nata treatment regimen.METHODS:One hundred and twenty eyes of 102 patients were enrolled in the study. The patients medical records were analyzed retrospectively. Best-corrected visual acuity (BCVA), central macular thickness (CMT), type of DME, presence of subretinal fluid, number and localization of hyperreflective dots, vitreomacular interface disorders, disorganization of the retinal inner layer (DRIL), inner segment/outer segment (IS/OS) junction-external limiting membrane (ELM) status, intraretinal cyst diameter and localization, and subfoveal choroidal thickness were examined in all patients.RESULTS:A statistically significant increase in BCVA and a decrease in CMT were detected in all treatment groups. When cases were evaluated in terms of BCVA before and after treatment, statistically significant differences were observed in the RNB and AFL groups at 1 and 4 months and in the DEX group during the 1st year. In terms of OCT biomarkers, visual recovery was obtained in cases of intact IS/OS-ELM and non-DRIL patients. In the serous macular detachment group, more visual gain was achieved with the RNB (1 and 4 months) and AFL (1, 4, and 6 months) agents compared to the DEX implant. On the other hand, in the group with cystoid macular edema, more visual gain was achieved with RNB compared to the DEX implant in all months, but more visual gain was achieved only in the 1st month with AFL administration.CONCLUSION:Significant improvement was achieved for both BCVA and CMT in all treatment groups. We expect that OCT-based prognostic factors will become more important in the treatment of DME and will be determining factors in the choice of treatment.

Treatment response to Conbercept of different types of diabetic macular edema classified based on optical coherence tomography

To compare different types of diabetic macular edema (DME) classified based on optical coherence tomography (OCT) for their responses to Conbercept injection and analyze the factors that affect the treatment responses. We retrospectively analyzed the clinical data of 65 patients (76 eyes) with DME diagnosed and treated with intravitreal injection of Conbercept (1+PRN) in our hospital from February, 2019 to February, 2021. According to OCT findings, DME in these patients was classified into cystic macular edema (CME; 28 eyes), serous retinal detachment (SRD; 33 eyes), and diffuse retinal thickening (DRT; 15 eyes). The best corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured before and at 3 months after the first treatment. The baseline OCT characteristics of different types of DME were compared, and the correlation of these OCT characteristics with the treatment response to Conbercept was analyzed. All the patients showed significant improvement of the BCVA 3 months after the treatment (P < 0.05). For all the 3 types of DME, the CRT at 3 months after the first treatment was significantly reduced as compared to the baseline (P < 0.05). The number of hyperreflective foci (HF) in the outer retina and the proportion of ellipsoid zone (EZ) interruption were the greatest in SRD group (P < 0.05). The baseline outer retinal HF was significantly correlated with the baseline CRT, CRT changes and CRT after treatment (all P < 0.05). The patients with baseline outer limiting membrane (ELM)/ EZ disruption had poorer baseline BCVA, greater baseline CRT, greater variation of CRT and poorer BCVA at 3 months after treatment (all P < 0.05). For all the 3 types of DME, treatment with intravitreal injection of Conbercept can significantly improve the BCVA and CRT of the patients. DME of the SRD type has the best morphological response to Conbercept, while the DRT type has a relatively poor response. A greater number of HF at baseline may indicate a better morphological response to Conbercept treatment, and baseline ELM/EZ disruption may suggest a poor visual prognosis at 3 months after treatment.

427-P: Prevalence and Treatment of Diabetic Macular Edema and Vision-Threatening Diabetic Retinopathy among Commercially Insured Adults Aged &amp;lt;65 Years

While diabetes prevalence in U.S. adults has increased in the last three decades, less is known about trends in ocular complications of diabetes, particularly in adults aged &amp;lt;65 years. We examined trends in prevalence and treatment of diabetic macular edema (DME) or vision-threatening diabetic retinopathy (DR) among commercially insured adults with diabetes. We analyzed claims from 2012 to 2018 using the IBM® MarketScan® Database, a national convenience sample of employer-sponsored health insurance. Analyses for each cross-sectional year included adults (18-64 years) with type 1 or 2 diabetes continuously enrolled for the calendar year (range: n=980,705 to n=1,715,815). Outcomes included the annual prevalence of those with ≥1 claim for: 1) DME or vision-threatening DR (severe non-proliferative DR or proliferative DR), 2) DME of any type, alone or with any stage of DR, and 3) treatment (anti-vascular endothelial growth factor [VEGF] injection, laser surgery/photocoagulation, vitrectomy, or retinal detachment repair). From 2012 to 2018, annual diabetes prevalence ranged from 7.3% to 7.8%. Annual prevalence of adults with diabetes who had ≥1 claim for DME or vision-threatening DR increased from 1.9% to 3.1% (Annual percent change [APC]: 0.23); any type of DME increased from 0.9% to 2.4% (APC: 0.29). Among those with DME or vision-threatening DR, annual prevalence of having ≥1 claim for treatment increased for anti-VEGF injection (21.9% to 31.2%; APC: 1.81) and decreased for laser surgery/photocoagulation (33.6% to 18.9%; APC: -2.65), vitrectomy (6.5% to 3.8%; APC: -0.48), and retinal detachment repair (3.9% to 2.9%; APC: -0.15). P-values for all trends were &amp;lt;0.01. From 2012 to 2018, among commercially insured adults aged &amp;lt;65 years, the annual prevalence of those with claims for DME or vision-threatening DR and DME of any type increased, coinciding with an increase in the use of anti-VEGF injection, a contemporary first-line treatment. Disclosure E. A. Lundeen: None. M. Kim: None. D. B. Rein: None. J. Wittenborn: None. C. Cai: None. J. B. Saaddine: None.

A study of therapeutic effects of 670 nm irradiation in different types of diabetic macular edema

The purpose of this study was to investigate the therapeutic effects of 670 nm irradiation in patients with diabetic macular edema. In several studies, positive effects of red/near-infrared irradiation showed in a range of ocular diseases such as macular degeneration, macular edema, and retinitis pigmentosa. This study was conducted on forty five eyes of 26 diabetic patients with macular edema between the ages of 51 and 80.Measurement of visual acuity and slit lamp examination, funduscopy, and optical coherence tomography were performed in all subjects. None of the patients had proliferative retinopathy. We used a portable LED device (Warp 10, Quantum Devices) for treatment. Patients held this device at a distance of 3 cm from their eyes for 240 seconds for three months. Full ophthalmic examinations were repeated 1, 2, and 3 months after treatment.After 3 months, the mean visual acuity improved from 0.44 ± 0.38 log MAR to 0.27 ± 0.24 log MAR and vision increased by 1.52 ± 1.16 lines post treatment (р&lt;0.001). The mean central macula thickness decreased from 381.49 ± 144.40 μm to 359.72 ± 128.84 μm (р=0.050). In patients with mild and moderate nonproliferative diabetic retinopathy, the mean central retinal thickness decreased 52.06 ± 67.78 μm and 39.27 ± 44.69 μm, respectively, but patients with severe type showed an increase of 34.93 ± 65.65 μm in the mean central retinal thickness (р&lt;0.001). Also, the severity of macular edema had no effect on final outcomes (р&gt;0.05). Photobiomodulation can positively affect diabetic macular edema, especially in patients with mild to moderate diabetic retinopathy.

Automated detection of multiple structural changes of diabetic macular oedema in SDOCT retinal images through transfer learning in CNNs

Diabetic Maculopathy, the major cause of vision loss, occurs due to uncontrolled diabetes. This affects the retinal layers of the eye causing bleeding of vessels, which results in Diabetic Macular Edema (DME), macular detachment etc., Basically three structural changes are involved in DME viz., Cystoid Macular Edema (CME), Serous Macular Detachment (SMD) and Intra Retinal Fluid (IRF). These changes may also coexist with each other such as CME with SMD or CME with IRF etc. In this work, the retinal images acquired through Spectral Domain Optical Coherence Tomography (SDOCT) imaging modality, which would provide high level of precision and resolution of the retinal layers are utilized. An automated algorithm to detect and differentiate seven types of DME based on deep learning is implemented using transfer learning on three Convolutional Neural Networks (CNNs), ResNet 50, VGGNet and AlexNet. In detection of DME, ResNet 50 performs excellently well, when compared with Alexnet and VGGNet, because of its depth and skip connection features. The average values of the statistical parameters such as accuracy (0.993), F1 score (0.975), Mathews Correlation Coefficient(MCC)(0.972) of ResNet are high when compared to that of AlexNet and VGGNet

Diabetic Macular Edema Characterization and Visualization Using Optical Coherence Tomography Images

Diabetic Retinopathy and Diabetic Macular Edema (DME) represent one of the main causes of blindness in developed countries. They are characterized by fluid deposits in the retinal layers, causing a progressive vision loss over the time. The clinical literature defines three DME types according to the texture and disposition of the fluid accumulations: Cystoid Macular Edema (CME), Diffuse Retinal Thickening (DRT) and Serous Retinal Detachment (SRD). Detecting each one is essential as, depending on their presence, the expert will decide on the adequate treatment of the pathology. In this work, we propose a robust detection and visualization methodology based on the analysis of independent image regions. We study a complete and heterogeneous library of 375 texture and intensity features in a dataset of 356 labeled images from two of the most used capture devices in the clinical domain: a CIRRUSTM HD-OCT 500 Carl Zeiss Meditec and 179 OCT images from a modular HRA + OCT SPECTRALIS® from Heidelberg Engineering, Inc. We extracted 33,810 samples for each type of DME for the feature analysis and incremental training of four different classifier paradigms. This way, we achieved an 84.04% average accuracy for CME, 78.44% average accuracy for DRT and 95.40% average accuracy for SRD. These models are used to generate an intuitive visualization of the fluid regions. We use an image sampling and voting strategy, resulting in a system capable of detecting and characterizing the three types of DME presenting them in an intuitive and repeatable way.

Functional and anatomical changes in diabetic macular edema after hemodialysis initiation: One-year follow-up multicenter study

Diabetic nephropathy and retinopathy (DR) including diabetic macular edema (DME) are representative microvascular complications of diabetes. We conducted a retrospective multicenter study analyzing records from patients with DR (132 eyes in 70 patients) and end-stage renal diseases (ESRD) who underwent hemodialysis for the first time. We demonstrated that the central retinal thickness (CRT) values were significantly decreased (p < 0.0001), and the best-corrected visual acuity (BCVA) values were improved (p < 0.05) at 1, 3, 6, 9, and 12 months after hemodialysis initiation, in spite of a lack of specific ocular treatments for DME in 93.2% of eyes. We found a significant positive correlation in the rates of CRT changes between right and left eyes. The CRT reductions were greater in eyes with DME type subretinal detachment than in those with spongelike swelling and cystoid macular edema. The visual outcome gain was associated with the CRT reduction at 12 months in the eyes with good initial BCVA (≧20/50). Hemodialysis induction contributed to functional and anatomical improvements after 1 year, independently of initial laboratory values before the hemodialysis.

Spectral domain optical coherence tomography classification of diabetic macular edema: a new proposal to clinical practice.

To classify the types of diabetic macular edema (DME) and evaluate its morphological features on spectral domain optical coherence tomography (SD-OCT) and determine correlations between visual acuity and OCT findings. We assessed 406 eyes of 309 patients with a diagnosis of DME retrospectively. Three types based on SD-OCT were identified: diffuse macular edema, cystoid macular edema, and cystoid degeneration. Morphological features such as serous macular detachment (SMD), vitreomacular interface abnormalities (VMAI), hard exudates, photoreceptor status, and correlations between visual acuity and those morphological features were also evaluated by SD-OCT. The most common type of DME was cystoid edema (68.5%). No statistically significant difference was found between groups in sex (P = 0.40), type of diabetes (P = 0.50), or diabetic retinopathy (P=0.78). However, the duration of symptoms and BCVA was significantly lower in the group with cystoid degeneration compared with the group with cystoid edema (P < 0.001) and the group with diffuse macular edema (P < 0.001). In the group with cystoid degeneration compared with the groups with cystoid and diffuse edema, the central fovea and central subfield were significantly thicker (both (P < 0.001), the subfoveal choroid was significantly thinner (P = 0.049), rate of serous macular detachment was significantly lower (P < 0.001), and the rate of outer retinal damage was significantly higher (P < 0.001). Cystoid macular degeneration, which is consistent with poor functional and morphological outcomes, should be differentiated from cystoid macular edema. Serous macular detachment, which is mostly seen in eyes with early stages of DME, should be evaluated as an accompanying morphological finding rather than a type of DME.

Effect of Optical Coherence Tomography Patterns on One-year Outcomes of Aflibercept Therapy for Diabetic Macular Edema.

To evaluate the outcomes of aflibercept based on different morphologic patterns on optical coherence tomography (OCT) for diabetic macular edema (DME). Observational study. Beyoglu Eye Training and Research Hospital, Turkey from February 2016 to March 2018. Records of 115 eyes of 115 patients who were treated with aflibercept for DME were reviewed. Eyes were classified based on OCT features as diffuse retinal thickening (DRT, n=37), cystoid macular edema (CME, n=40), and serous retinal detachment (SRD, n=38). Best-corrected visual acuity (BCVA) and central subfield retinal thickness (CST) at baseline and after three doses of aflibercept at months 3, 6, 12 were recorded. Primary outcome measures were the changes in BCVA and CST at follow-up visits compared with baseline. At month 3, mean BCVA was improved in all groups. Although the increase in BCVA at month 3 was significant in DRT and CME groups, it was not significant in SRD group (p=0.03, p<0.01, and p=0.22, respectively). At month 12, BCVA significantly improved compared to baseline values in DRT, CME, and SRD groups (p=0.01, p=0.01 and p<0.01, respectively). There was no significant difference between groups in terms of BCVA at baseline and months 3, 6, 12 (p=0.13, p=0.67, p=0.54, and p=0.28, respectively). Mean CST significantly decreased compared to baseline values at the end of month 12 (all p<0.01). Aflibercept therapy provided an improvement in visual acuity and decreased CST in different morphological DME types for one year. The number of injections that could achieve this efficacy was least in DRT group, and more injections were required in SRD group.

Association of Types of Diabetic Macular Edema with Different Anti-Diabetic Therapies

Association of Types of Diabetic Macular Edema with Different Anti-Diabetic Therapies

Role of Inflammation in Classification of Diabetic Macular Edema by Optical Coherence Tomography.

Diabetic macular edema (DME) is the abnormal accumulation of fluid in the subretinal or intraretinal spaces in the macula in patients with diabetic retinopathy and leads to severely impaired central vision. Technical developments in retinal imaging systems have led to many advances in the study of DME. In particular, optical coherence tomography (OCT) can provide longitudinal and microstructural analysis of the macula. A comprehensive review was provided regarding the role of inflammation using OCT-based classification of DME and current and ongoing therapeutic approaches. In this review, we first describe the pathogenesis of DME, then discuss the classification of DME based on OCT findings and the association of different types of DME with inflammation, and finally describe current and ongoing therapeutic approaches using OCT-based classification of DME. Inflammation has an important role in the pathogenesis of DME, but its role appears to differ among the DME phenotypes, as determined by OCT. It is important to determine how the different DME subtypes respond to intravitreal injections of steroids, antivascular endothelial growth factor agents, and other drugs to improve prognosis and responsiveness to treatment.

Incidence of different morphological types of diabetic macular edema on OCT in western Indian Population

Incidence of different morphological types of diabetic macular edema on OCT in western Indian Population

Evidence-Based Guidelines for Management of Diabetic Macular Edema

Purpose: The purpose of this article is to provide a data-driven set of best practices to consider in the management of diabetic macular edema (DME). Methods: The current discussion and recommendations represent the authors’ interpretations of data from selected references based on perceived relevance and study design. Results: DME is a common cause of visual impairment globally. The underlying progressive retinal microvascular damage is associated with upregulation of VEGF and a multitude of other inflammatory pathways. Three clinically relevant subcategories of DME can be identified: central-involved DME (CIDME) with preserved visual acuity, CIDME with associated visual loss, and non-CIDME. Management approaches may include observation, laser photocoagulation, intravitreal pharmacotherapy with anti-VEGF agents or corticosteroids, or a combination of these, and may vary depending on the specific type of DME and associated severity of diabetic retinopathy. Additional factors to consider in the management of patients with DME include the appropriate use of imaging and recognition of the chronic nature of the underlying disease process in many eyes. Conclusions: DME management is complex. Intravitreal pharmacotherapies are the current cornerstone of treatment for CIDME and appear poised to remain so for the foreseeable future.

Combination therapy in patients with concomitant macular edema and proliferative diabetic retinopathy

To study the effectiveness of the combination of intravitreal administration of the drug Ozurdex with subsequent individually selected laser therapy in the treatment of the proliferative stage of diabetic retinopathy in patients with concomitant chronic DME, and its relationship with morphological changes in the retina observed with optical coherence tomography. This retrospective study included 18 patients with insulin-requiring type II diabetes mellitus complicated by diabetic retinopathy in the proliferative stage and refractory DME. According to morphological changes observed with optical coherence tomography of the retina, the patients were divided into 3 groups: 6 patients with diffuse macular edema, 6 patients with cystic macular edema, and 6 patients with serous detachment of the retinal neuroepithelium. All patients underwent intravitreal injection of 0.7 mg Ozurdex followed by panretinal laser coagulation. The choice of laser applicates with the minimal parameters giving a therapeutic effect was carried out according to the procedure described previously (Patent No. RU2611887C1 d.d. 12/25/2015). The combination of intravitreal administration of Ozurdex followed by individually selected laser coagulation is effective against various morphological types of DME. However, the greatest visual acuity was achieved in patients with diffuse macular edema and retinal neuroepithelial detachment. The higher the initial visual acuity, the better the functional outcomes of the treatment. Baseline retinal thickness did not affect the effectiveness of the proposed method of treatment. Cystic macular edema was an unfavorable prognostic factor for improving visual acuity.