Diabetic macular edema: Evidence-based management.

Published

Journal Article (Review)

Diabetic macular edema (DME) is the most common cause of vision loss in patients with diabetic retinopathy with an increasing prevalence tied to the global epidemic in type 2 diabetes mellitus. Its pathophysiology starts with decreased retinal oxygen tension that manifests as retinal capillary hyperpermeability and increased intravascular pressure mediated by vascular endothelial growth factor (VEGF) upregulation and retinal vascular autoregulation, respectively. Spectral domain optical coherence tomography (SD-OCT) is the cornerstone of clinical assessment of DME. The foundation of treatment is metabolic control of hyperglycemia and blood pressure. Specific ophthalmic treatments include intravitreal anti-VEGF drug injections, intravitreal corticosteroid injections, focal laser photocoagulation, and vitrectomy, but a substantial fraction of eyes respond incompletely to all of these modalities resulting in visual loss and disordered retinal structure and vasculature visible on SD-OCT and OCT angiography. Efforts to close the gap between the results of interventions within randomized clinical trials and in real-world contexts, and to reduce the cost of care increasingly occupy innovation in the social organization of ophthalmic care of DME. Pharmacologic research is exploring other biochemical pathways involved in retinal vascular homeostasis that may provide new points of intervention effective in those cases unresponsive to current treatments.

Full Text

Duke Authors

Cited Authors

  • Browning, DJ; Stewart, MW; Lee, C

Published Date

  • December 2018

Published In

Volume / Issue

  • 66 / 12

Start / End Page

  • 1736 - 1750

PubMed ID

  • 30451174

Pubmed Central ID

  • 30451174

Electronic International Standard Serial Number (EISSN)

  • 1998-3689

International Standard Serial Number (ISSN)

  • 0301-4738

Digital Object Identifier (DOI)

  • 10.4103/ijo.IJO_1240_18

Language

  • eng