Advances in the treatment strategies of diabetic macular edema and the problems_Chinese Journal of Ocular Fundus Diseases

Authors：

 Dai Hong , Lu Yingyi

Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China;

Corresponding?author：

Dai Hong, Email: Dai-Hong@x263.net

Keywords：

Diabetic retinopathy; Macular edema; Angiogenesis inhibitors; Editorial

DOI：

10.3760/cma.j.cn511434-20220104-00007

Video：

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Abstract Full text Figures/Tables Video References Cited by

Diabetic macular edema (DME) is one of the common causes of visual impairment. Anti-vascular endothelial growth factor (VEGF) has become the preferred therapy for DME because of significant visual improvement. Early and intensive anti-VEGF therapy combined with other individualized treatments are currently the main strategy for DME treatment. Considering the complexity of DME and limitations of anti-VEGF therapy, there are still many problems and difficulties in the treatment of DME. Optimizing treatment strategies, strengthening management of the clinical course and developing new drugs, could improve the efficacy and maintain the improvement of visual acuity and visual performance.

Citation： Dai Hong, Lu Yingyi. Advances in the treatment strategies of diabetic macular edema and the problems. Chinese Journal of Ocular Fundus Diseases, 2022, 38(1): 6-9. doi: 10.3760/cma.j.cn511434-20220104-00007 Copy

1.	Bressler NM, Odia I, Maguire M, et al. Association between change in visual acuity and change in central subfield thickness during treatment of diabetic macular edema in participants randomized to aflibercept, bevacizumab, or ranibizumab: a post hoc analysis of the protocol T randomized clinical trial[J]. JAMA Ophthalmol, 2019, 137(9): 977-985. DOI: 10.1001/jamaophthalmol.2019.1963.
2.	Ciulla TA, Pollack JS, Williams DF. Visual acuity outcomes and anti-VEGF therapy intensity in diabetic macular oedema: a real-world analysis of 28 658 patient eyes[J]. Br J Ophthalmol, 2021, 105(2): 216-221. DOI: 10.1136/bjophthalmol-2020-315933.
3.	Kodjikian L, Bellocq D, Bandello F, et al. First-line treatment algorithm and guidelines in center-involving diabetic macular edema[J]. Eur J Ophthalmol, 2019, 29(6): 573-584. DOI: 10.1177/1120672119857511.
4.	Bressler SB, Glassman AR, Almukhtar T, et al. Five-year outcomes of ranibizumab with prompt or deferred laser versus laser or triamcinolone plus deferred ranibizumab for diabetic macular edema[J]. Am J Ophthalmol, 2016, 164: 57-68. DOI: 10.1016/j.ajo.2015.12.025.
5.	Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, et al. Guidelines for the management of diabetic macular edema by the European society of retina specialists (EURETINA)[J]. Ophthalmologica, 2017, 237(4): 185-222. DOI: 10.1159/000458539.
6.	American Academy of Ophthalmology. Diabetic Retinopathy PPP [M]. Amsterdam: Elsevier Inc, 2014.
7.	American Academy of Ophthalmology. Diabetic Retinopathy PPP [M]. Amsterdam: Elsevier Inc, 2017.
8.	American Academy of Ophthalmology. Diabetic Retinopathy PPP [M]. Amsterdam: Elsevier Inc, 2019.
9.	Wong TY, Sun J, Kawasaki R, et al. Guidelines on diabetic eye care: the international council of ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings[J]. Ophthalmology, 2018, 125(10): 1608-1622. DOI: 10.1016/j.ophtha.2018.04.007.
10.	Cheung GC, Yoon YH, Chen LJ, et al. Diabetic macular oedema: evidence-based treatment recommendations for Asian countries[J]. Clin Exp Ophthalmol, 2018, 46(1): 75-86. DOI: 10.1111/ceo.12999.
11.	Chhablani J, Wong K, Tan GS, et al. Diabetic macular edema management in Asian population: expert panel consensus guidelines[J]. Asia Pac J Ophthalmol (Phila), 2020, 9(5): 426-434. DOI: 10.1097/APO.0000000000000312.
12.	Chen JT, Chen LJ, Chen SN, et al. Management of diabetic macular edema: experts' consensus in Taiwan[J]. Jpn J Ophthalmol, 2020, 64(3): 235-242. DOI: 10.1007/s10384-020-00741-4.
13.	Lukic M, Williams G, Shalchi Z, et al. Intravitreal aflibercept for diabetic macular oedema: Moorfields' real-world 12-month visual acuity and anatomical outcomes[J]. Eur J Ophthalmol, 2020, 30(3): 557-562. DOI: 10.1177/1120672119833270.
14.	戴虹, 盧穎毅. 糖尿病黃斑水腫治療方案的選擇及需要關注的幾個問題[J]. 中華實驗眼科雜志, 2016, 34(12): 1061-1064. DOI: 10.3760/cma.j.issn.2095-0160.2016.12.002.Dai H, Lu YY. Choice of current approaches to the management of diabetic macular edema[J]. Chin J Exp Ophthalmol, 2016, 34(12): 1061-1064. DOI: 10.3760/cma.j.issn.2095-0160.2016.12.002.
15.	盧穎毅, 戴虹. 從最新的指南看糖尿病黃斑水腫的治療策略和方案[J]. 中華實驗眼科雜志, 2018, 36(6): 401-403. DOI: 10.3760/cma.j.issn.2095-0160.2018.06.001.Lu YY, Dai H. Treatment strategy and plan for diabetic macular edema based on the latest guidelines[J]. Chin J Exp Ophthalmol, 2018, 36(6): 401-403. DOI: 10.3760/cma.j.issn.2095-0160.2018.06.001.
16.	García Layana A, Adán A, Ascaso FJ, et al. Use of intravitreal dexamethasone implants in the treatment of diabetic macular edema: expert recommendations using a Delphi approach[J]. Eur J Ophthalmol, 2020, 30(5): 1042-1052. DOI: 10.1177/1120672119861623.
17.	Castro Farías D, Matsui Serrano R, Bianchi Gancharov J, et al. Indocyanine green angiography for identifying telangiectatic capillaries in diabetic macular oedema[J]. Br J Ophthalmol, 2020, 104(4): 509-513. DOI: 10.1136/bjophthalmol-2019-314355.
18.	呂林, 陳士達. 微創玻璃體手術時代: 糖尿病視網膜病變手術的新認識[J]. 中華眼底病雜志, 2021, 38(12): 1-5. DOI: 10.3760/cma.j.cn511434-20211206-00681.Lyu L, Chen SD. The era of minimally invasive vitreous surgery: new insights into diabetic retinopathy surgery[J]. Chin J Ocul Fundus Dis, 2021, 38(12): 1-5. DOI: 10.3760/cma.j.cn511434-20211206-00681.
19.	中華醫學會糖尿病學分會視網膜病變學組. 糖尿病相關眼病防治多學科中國專家共識(2021年版)[J]. 中華糖尿病雜志, 2021, 13(11): 1026-1042. DOI: 10.3760/cma.j.cn115791-20211006-00534.Retinopathy Group of Diabetes Branch of Chinese Medical Association. Chinese multidisciplinary expert consensus on the prevention and treatment of diabetic eye disease (2021 edition)[J]. Chin J Diabetes Mellitus, 2021, 13(11): 1026-1042. DOI: 10.3760/cma.j.cn115791-20211006-00534.
20.	Korobelnik JF, Daien V, Faure C, et al. Real-world outcomes following 12 months of intravitreal aflibercept monotherapy in patients with diabetic macular edema in France: results from the APOLLON study[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(3): 521-528. DOI: 10.1007/s00417-019-04592-9.
21.	Glassman AR, Wells JA 3rd, Josic K, et al. Five-year outcomes after initial flibercept, bevacizumab, or ranibizumab treatment for diabetic macular edema (protocol T extension study)[J]. Ophthalmology, 2020, 127(9): 1201-1210. DOI: 10.1016/j.ophtha.2020.03.021.
22.	趙晶, 戴虹. 中國抗血管內皮生長因子藥物眼科臨床應用現狀及存在問題[J]. 臨床藥物治療雜志, 2020, 18(12): 1-5. DOI: 10.3969/j.issn.1672-3384.2020.12.001.Zhao J, Dai H. Status and challenges of anti-vascular endothelial growth factor usage in ophthalmic diseases in China[J]. Clinical Medication Journal, 2020, 18(12): 1-5. DOI: 10.3969/j.issn.1672-3384.2020.12.001.
23.	Bressler NM, Beaulieu WT, Glassman AR, et al. Persistent macular thickening following intravitreous aflibercept, bevacizumab, or ranibizumab for central-involved diabetic macular edema with vision impairment: a secondary analysis of a randomized clinical trial[J]. JAMA Ophthalmol, 2018, 136(3): 257-269. DOI: 10.1001/jamaophthalmol.2017.6565.
24.	許迅, 黎曉新. 我國眼底病專業領域發展70年回顧[J]. 中華眼科雜志, 2020, 56(4): 241-245. DOI: 10.3760/cma.j.cn112142-20200207-00051.Xu X, Li XX. A summary of ocular fundus diseases in China over the past 70 years[J]. Chin J Ophthalmol, 2020, 56(4): 241-245. DOI: 10.3760/cma.j.cn112142-20200207-00051.

1. Bressler NM, Odia I, Maguire M, et al. Association between change in visual acuity and change in central subfield thickness during treatment of diabetic macular edema in participants randomized to aflibercept, bevacizumab, or ranibizumab: a post hoc analysis of the protocol T randomized clinical trial[J]. JAMA Ophthalmol, 2019, 137(9): 977-985. DOI: 10.1001/jamaophthalmol.2019.1963.
2. Ciulla TA, Pollack JS, Williams DF. Visual acuity outcomes and anti-VEGF therapy intensity in diabetic macular oedema: a real-world analysis of 28 658 patient eyes[J]. Br J Ophthalmol, 2021, 105(2): 216-221. DOI: 10.1136/bjophthalmol-2020-315933.
3. Kodjikian L, Bellocq D, Bandello F, et al. First-line treatment algorithm and guidelines in center-involving diabetic macular edema[J]. Eur J Ophthalmol, 2019, 29(6): 573-584. DOI: 10.1177/1120672119857511.
4. Bressler SB, Glassman AR, Almukhtar T, et al. Five-year outcomes of ranibizumab with prompt or deferred laser versus laser or triamcinolone plus deferred ranibizumab for diabetic macular edema[J]. Am J Ophthalmol, 2016, 164: 57-68. DOI: 10.1016/j.ajo.2015.12.025.
5. Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, et al. Guidelines for the management of diabetic macular edema by the European society of retina specialists (EURETINA)[J]. Ophthalmologica, 2017, 237(4): 185-222. DOI: 10.1159/000458539.
6. American Academy of Ophthalmology. Diabetic Retinopathy PPP [M]. Amsterdam: Elsevier Inc, 2014.
7. American Academy of Ophthalmology. Diabetic Retinopathy PPP [M]. Amsterdam: Elsevier Inc, 2017.
8. American Academy of Ophthalmology. Diabetic Retinopathy PPP [M]. Amsterdam: Elsevier Inc, 2019.
9. Wong TY, Sun J, Kawasaki R, et al. Guidelines on diabetic eye care: the international council of ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings[J]. Ophthalmology, 2018, 125(10): 1608-1622. DOI: 10.1016/j.ophtha.2018.04.007.
10. Cheung GC, Yoon YH, Chen LJ, et al. Diabetic macular oedema: evidence-based treatment recommendations for Asian countries[J]. Clin Exp Ophthalmol, 2018, 46(1): 75-86. DOI: 10.1111/ceo.12999.
11. Chhablani J, Wong K, Tan GS, et al. Diabetic macular edema management in Asian population: expert panel consensus guidelines[J]. Asia Pac J Ophthalmol (Phila), 2020, 9(5): 426-434. DOI: 10.1097/APO.0000000000000312.
12. Chen JT, Chen LJ, Chen SN, et al. Management of diabetic macular edema: experts' consensus in Taiwan[J]. Jpn J Ophthalmol, 2020, 64(3): 235-242. DOI: 10.1007/s10384-020-00741-4.
13. Lukic M, Williams G, Shalchi Z, et al. Intravitreal aflibercept for diabetic macular oedema: Moorfields' real-world 12-month visual acuity and anatomical outcomes[J]. Eur J Ophthalmol, 2020, 30(3): 557-562. DOI: 10.1177/1120672119833270.
14. 戴虹, 盧穎毅. 糖尿病黃斑水腫治療方案的選擇及需要關注的幾個問題[J]. 中華實驗眼科雜志, 2016, 34(12): 1061-1064. DOI: 10.3760/cma.j.issn.2095-0160.2016.12.002.Dai H, Lu YY. Choice of current approaches to the management of diabetic macular edema[J]. Chin J Exp Ophthalmol, 2016, 34(12): 1061-1064. DOI: 10.3760/cma.j.issn.2095-0160.2016.12.002.
15. 盧穎毅, 戴虹. 從最新的指南看糖尿病黃斑水腫的治療策略和方案[J]. 中華實驗眼科雜志, 2018, 36(6): 401-403. DOI: 10.3760/cma.j.issn.2095-0160.2018.06.001.Lu YY, Dai H. Treatment strategy and plan for diabetic macular edema based on the latest guidelines[J]. Chin J Exp Ophthalmol, 2018, 36(6): 401-403. DOI: 10.3760/cma.j.issn.2095-0160.2018.06.001.
16. García Layana A, Adán A, Ascaso FJ, et al. Use of intravitreal dexamethasone implants in the treatment of diabetic macular edema: expert recommendations using a Delphi approach[J]. Eur J Ophthalmol, 2020, 30(5): 1042-1052. DOI: 10.1177/1120672119861623.
17. Castro Farías D, Matsui Serrano R, Bianchi Gancharov J, et al. Indocyanine green angiography for identifying telangiectatic capillaries in diabetic macular oedema[J]. Br J Ophthalmol, 2020, 104(4): 509-513. DOI: 10.1136/bjophthalmol-2019-314355.
18. 呂林, 陳士達. 微創玻璃體手術時代: 糖尿病視網膜病變手術的新認識[J]. 中華眼底病雜志, 2021, 38(12): 1-5. DOI: 10.3760/cma.j.cn511434-20211206-00681.Lyu L, Chen SD. The era of minimally invasive vitreous surgery: new insights into diabetic retinopathy surgery[J]. Chin J Ocul Fundus Dis, 2021, 38(12): 1-5. DOI: 10.3760/cma.j.cn511434-20211206-00681.
19. 中華醫學會糖尿病學分會視網膜病變學組. 糖尿病相關眼病防治多學科中國專家共識(2021年版)[J]. 中華糖尿病雜志, 2021, 13(11): 1026-1042. DOI: 10.3760/cma.j.cn115791-20211006-00534.Retinopathy Group of Diabetes Branch of Chinese Medical Association. Chinese multidisciplinary expert consensus on the prevention and treatment of diabetic eye disease (2021 edition)[J]. Chin J Diabetes Mellitus, 2021, 13(11): 1026-1042. DOI: 10.3760/cma.j.cn115791-20211006-00534.
20. Korobelnik JF, Daien V, Faure C, et al. Real-world outcomes following 12 months of intravitreal aflibercept monotherapy in patients with diabetic macular edema in France: results from the APOLLON study[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(3): 521-528. DOI: 10.1007/s00417-019-04592-9.
21. Glassman AR, Wells JA 3rd, Josic K, et al. Five-year outcomes after initial flibercept, bevacizumab, or ranibizumab treatment for diabetic macular edema (protocol T extension study)[J]. Ophthalmology, 2020, 127(9): 1201-1210. DOI: 10.1016/j.ophtha.2020.03.021.
22. 趙晶, 戴虹. 中國抗血管內皮生長因子藥物眼科臨床應用現狀及存在問題[J]. 臨床藥物治療雜志, 2020, 18(12): 1-5. DOI: 10.3969/j.issn.1672-3384.2020.12.001.Zhao J, Dai H. Status and challenges of anti-vascular endothelial growth factor usage in ophthalmic diseases in China[J]. Clinical Medication Journal, 2020, 18(12): 1-5. DOI: 10.3969/j.issn.1672-3384.2020.12.001.
23. Bressler NM, Beaulieu WT, Glassman AR, et al. Persistent macular thickening following intravitreous aflibercept, bevacizumab, or ranibizumab for central-involved diabetic macular edema with vision impairment: a secondary analysis of a randomized clinical trial[J]. JAMA Ophthalmol, 2018, 136(3): 257-269. DOI: 10.1001/jamaophthalmol.2017.6565.
24. 許迅, 黎曉新. 我國眼底病專業領域發展70年回顧[J]. 中華眼科雜志, 2020, 56(4): 241-245. DOI: 10.3760/cma.j.cn112142-20200207-00051.Xu X, Li XX. A summary of ocular fundus diseases in China over the past 70 years[J]. Chin J Ophthalmol, 2020, 56(4): 241-245. DOI: 10.3760/cma.j.cn112142-20200207-00051.

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Advances in the treatment strategies of diabetic macular edema and the problems

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