Diabetic Macular Edema

Quantitative assessment of retinovascular features on ultra-widefield angiography images showed significant improvements in leakage and ischemia following treatment with aflibercept in patients with diabetic macular edema and retinal vein occlusion.

Development of technologies for sustained drug delivery is a topic of great interest among retina specialists considering the number of chronic conditions that are managed with repeated intravitreal injections.

The fluocinolone acetonide 0.2 mcg/day implant (Iluvien, Alimera Sciences) offers an additional option for treating diabetic macular edema that reduces the need for subsequent therapy with anti-vascular endothelial growth factor or steroid treatment.

The visual outcomes after anti-VEGF therapy administered to treat diabetic macular edema in the “real world” do not achieve those reported in randomized clinical trials. Eyes with better baseline visual acuity are disproportionately affected.

ALG-1001 is an integrin receptor inhibitor that acts to stabilize the retina’s response to diabetes-related hypoxic and oxidative stress, mitigating production of a host of molecules involved in the development of diabetic macular edema.

ALG-1001 (Luminate, Allegro Ophthalmics) has a number of different mechanisms of action that benefit patients chronically treated with anti-vascular endothelial growth factor drugs and those who are treatment naïve.

Patients with diabetic retinopathy have a high risk of developing macular edema after cataract surgery. Intravitreal injections of aflibercept might result in fewer patients developing macular edema in this patient population.

In the current era where pharmacologic therapy is the preferred treatment for macular edema secondary to retinal vein occlusion (RVO), there is still a role for laser, according to Francesco Bandello, MD.

Optical coherence tomography angiography (OCTA) is a promising new approach for visualizing retinal vascular pathology in eyes with diabetic eye disease that can be expected to have even greater utility in the future pending further enhancements.

The presence of vitreomacular adhesion (VMA) is associated with poorer, short-term anatomic, and functional outcomes in eyes with diabetic macular edema (DME) receiving anti-VEGF therapy, according to Márcio B. Nehemy, MD, PhD.

Findings from studies investigating intravitreal corticosteroids for treatment of diabetic macular edema (DME) provide information about their efficacy and safety, including some understanding of how they compare with anti-VEGF therapy.

Anti-vascular endothelial growth factor (VEGF) remains the gold standard therapy for diabetic retinopathy, but “when treating diabetic macular edema (DME), “about half of the patients treated with VEGF inhibitors do not respond to therapy,” said Tine Van Bergen, PhD, a scientist with ThromboGenics, Leuven, Belgium.

The efficacy of intravitreal bevacizumab (Avastin, Genentech) for improving vision in patients with center-involving diabetic macular edema (DME) has been demonstrated in several clinical trials.

All three anti-vascular endothelial growth factor (anti-VEGF) agents that are commercially available have demonstrated efficacy for the treatment of diabetic macular edema (DME). However, it is clear from the results of clinical trials that outcomes with bevacizumab are not as good as those obtained using ranibizumab or aflibercept, according to Jean-François Korobelnik, MD.

Activation of Tie2–as a result of subcutaneous administration of AKB-9778 (Aerpio Therapeutics) in combination with an anti-vascular endothelial growth factor (anti-VEGF) therapy–enhances the effect of an anti-VEGF drug on diabetic macular edema (DME).

Analyses of data collected in the RISE/RIDE and VIVID/VISTA clinical trials provide important messages about the efficacy and safety of ranibizumab (Lucentis, Genentech) and aflibercept (Eylea, Regeneron) for treatment of diabetic macular edema (DME).

The Diabetic Retinopathy Clinical Research Network’s (DRCR.net) Protocol T-the first head-to-head-to-head comparison among aflibercept (Eylea, Renegeron Pharmaceuticals), ranibizumab (Lucentis, Genentech), and bevacizumab (Avastin, Genentech)-found in its first-year results that all three agents improved vision and reduced edema effectively.

The scientific community knows that vascular endothelial growth factor (VEGF) causes increased, vascular permeability, resulting in diabetic macular edema (DME) in the ischemic retina, but how to stop the VEGF drive remains the challenge.

Ophthalmologists were asked what their plans were for using OCT angiography. You can participate in the survey and gain access to the full survey results by visiting www.practice-scope.com/#register.

Abicipar pegol (Allergan/Molecular Partners) met its primary and key secondary endpoints and demonstrated an acceptable overall safety profile in a phase II trial investigating use of the novel anti-VEGF-A agent for treatment of diabetic macular edema (DME).

Sustained intraocular delivery of fluocinolone acetonide (FAc) using the FAc 0.19 mg intravitreal implant (Iluvien, Alimera Sciences) improves and slows progression of diabetic retinopathy (DR), according to findings of post-hoc analyses of data from the pivotal Fluocinolone Acetonide for Diabetic Macular Edema (FAME) trials.

Treating diabetic macular edema (DME) has evolved from the ETDRS-style focal/grid laser being the standard of care since 1985 to the modern era of pharmacotherapy-with anti-vascular endothelial growth factor (VEGF) injections now taking center stage as primary treatment for most patients.

Volume-rendered optical coherence tomography (OCT) imaging allows new insight into retinal vascular flow and morphological changes in eyes with macular edema (ME), and the information obtained is the basis for new ideas about the pathogenesis of ME and therapeutic intervention, according to Richard F. Spaide, MD, Vitreous Retina Macula Consultants of New York.

Results from the phase II TANZANITE clinical trial support further investigation of adding suprachoroidal triamcinolone acetonide to anti-vascular endothelial growth factor therapy for treatment-naïve retinal vein occlusion.

Researchers have identified a new biomarker they believe can be used as a predictor of vision change in patients with diabetic macular edema, either during the natural history of the disease or after undergoing anti-VEGF therapy. The biomarker is disorganization of the retinal inner layers, or DRIL.

A new class of ophthalmic drug continues to show promise for treating patients with diabetic macular edema (DME).

When it comes to finding new treatments for diabetic macular edema (DME), there is no shortage of promising targets, said Peter A. Campochiaro, MD. He presented an overview of future compounds with various mechanisms of action that may change how clinicians treat DME.

Earlier treatment of patients with DME who have had visual acuity loss results in the need for fewer intravitreal injections of ranibizumab over the long term.

The increasing prevalence of diabetes, which implies a rise in the number of cases of diabetic retinopathy, suggests that ophthalmologists need to ensure their knowledge of this disease is up-to-date. Hazy memories of a long-ago medical school lecture from an endocrinologist or the guidelines in an outdated textbook are inadequate given changes in the understanding of the pathogenesis, diagnosis, and especially the treatment of diabetes.

A real-world safety study of fluocinolone acetonide implant (Iluvien, Alimera Sciences) in patients with chronic DME (328 eyes from 292 patients) showed that 81.6% of patients did not require initiation of IOP-lowering therapy during the study and 60% of patients included in this registry study gained vision after injection of Iluvien that was sustained over the study period.