Diabetic Macular Edema

Findings from the PERMEATE study used novel diagnostics to quantify response to intravitreal injections

Combination therapy benefits from laser in the mix for DME, other conditions

Factoring in that patients require continual and constant monitoring, maintenance

A phase II clinical trial evaluating suprachoroidal CLS-TA used with intravitreally administered aflibercept in patients with diabetic macular edema (DME) over a 6-month evaluation period-has met both primary and secondary endpoints of vision and anatomic improvement. 

Compared with intravitreous ranibizumab, the decreases in the plasma-free VEGF levels were greater with intravitreous aflibercept and bevacizumab in patients with diabetic macular edema.

With the first ocular gene therapy approved in the United States, Szilard Kiss, MD, points out that the gene therapy era for retinal disease has arrived, “and hopefully it will arrive for age-related macular degeneration.”

Among a subset of patients in the phase IV PALADIN study, there was improved visual acuity, improved macular thickness, and reduced treatment burden among patients treated with the intravitreal fluocinolone acetonide 0.2 µg (Iluvien implant) for DME.

The addition of dexamethasone implant (Ozurdex, Allergan) to a continuing regimen of ranibizumab (Lucentis, Genentech) did not produce results in visual acuity outcomes that differed from those achieved with ranibizumab alone at 6 months. However, there was an improvement in the central macular thickness on OCT in patients.

The use of aflibercept led to greater improvement in macular perfusion status in a phase III trial with DME patients. Those with baseline nonperfusion tended to have more advanced disease.

There is subset of patients with resistant or persistent DME that forms the impetus for new treatment strategies, including next-generation anti-VEGF-A and new classes of drugs. Pravin U. Dugel, MD, outlines a list of potential treatment candidates that may lead that paradigm shift.