Diabetic Macular Edema: State of Art and Intraocular Pharmacological Approaches
Diabetic macular edema (DME) is the main cause of vision loss in diabetic retinopathy (DR). Although it is one of the main complications of diabetes, the pathogenesis of DME is not completely understood. The hyperglycemic state promotes the activation of
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Diabetic Macular Edema: State of Art and Intraocular Pharmacological Approaches Annalisa Gurreri and Alberto Pazzaglia description and analysis of the current intravitreal therapeutic pharmacological strategies. Current guidelines recommend anti-VEGF as first line therapy in DME. Corticosteroids are becoming increasingly relevant blocking the inflammatory cascade and indirectly reducing VEGF synthesis.
Abstract
Diabetic macular edema (DME) is the main cause of vision loss in diabetic retinopathy (DR). Although it is one of the main complications of diabetes, the pathogenesis of DME is not completely understood. The hyperglycemic state promotes the activation of multiple interlinked pathways leading to DME. Different classifications have been proposed: based on clinical features, on pathogenesis or on diagnostic tests (optical coherence tomography – OCT and fluorescin angiography – FA). The multimodal imaging allows a better analysis of the morphological features of the DME. Indeed, new inflammatory biomarkers have been identified on OCT. Also, several studies are evaluating the role of the morphological features, identified on multimodal imaging, to find new prognostic factors. Over the past decade, great progresses have been made in the management of DME. Therapeutic alternatives include intraocular injection of anti-vascular endothelial grow factor agents (anti-VEGF) and steroid molecules, focal/grid laser photocoagulation and vitreoretinal surgery. This review is focused on the A. Gurreri (*) University of Bologna, Bologna, Italy Sant’ Orsola Malpighi Hospital, Bologna, Italy e-mail: [email protected] A. Pazzaglia Sant’ Orsola Malpighi Hospital, Bologna, Italy
Keywords
Diabetic macular edema · OCT · OCT-A · Fluorangiography · Pharmacological approaches · Anti-VEGF · Steroids
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Introduction
Diabetes mellitus (DM) is a serious, long-term condition with a major impact on the lives of individuals, families, and societies worldwide (Caruso et al. 2018). According to the 9th Edition of International Diabetes Federation (IDF) the worldwide prevalence of diabetes is increasing and it is estimated that 463 million people have diabetes. Also it is predicted that 578 million people will have diabetes in 2030 and the number will increase by 51% (700 million) in 2045. This foreseen increase is probably linked to a raise in obesity and the increase in life expectancy worldwide (Saeedi et al. 2019). At DM diagnosis half of the patients with DM present with complications, as it is a condition
A. Gurreri and A. Pazzaglia
that could be paucisymptomatic for years (Saeedi et al. 2019). The most common DM complications include macroangiopathy (myocardial infarction or vasculocerebral stroke) and microangiopathy (diabetic nephropathy, neuropathy, and retinopathy). In this chapter we will discuss diabetic retinopathy (DR) and in particular diabetic macular edema (DME). DME is the leading cause of blindness
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