Diabetic Macular Edema: Current Understanding, Pharmacologic Treatment Options, and Developing Therapies

Asia-Pacific Journal of Ophthalmology
Kevin Miller, Jorge A Fortun

Abstract

Diabetic retinopathy and diabetic macular edema comprise a major source of visual disability throughout the developed world. The etiology and pathogenesis of macular edema is intricate and multifactorial, in which the hyperglycemic state in diabetes induces a microangiopathy. Through several inflammatory and vasogenic mediators, including vascular endothelial growth factor (VEGF) upregulation and inflammatory cytokines and chemokines, pathologic changes are induced in the vascular endothelium triggering breakdown of the blood retinal barrier, causing extravasation of fluid into the extracellular space and manifesting clinically as macular edema, resulting in visual loss. The advent of medications targeting the VEGF pathway has led to great clinical improvements compared with the previous standard of care of laser therapy alone, as shown in studies such as RISE, RIDE, VIVID, VISTA, and DRCR. However, analyses have shown that many patients have inadequate response or are nonresponders to anti-VEGF therapy, demonstrating the need for additional therapies to more comprehensively treat this disease. Although corticosteroid treatments and implants have demonstrated some efficacy in adjunctive and supplemental treatment, the need to m...Continue Reading

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Citations

Feb 24, 2018·Asia-Pacific Journal of Ophthalmology·Suber S Huang, Lihteh Wu
Feb 14, 2019·European Journal of Ophthalmology·Abdullah OzkayaAsli Kirmaci
Apr 14, 2020·Journal of Ophthalmology·Mojca UrbančičAlenka Lavrič
Mar 9, 2021·Journal of Cell Communication and Signaling·Alberto Fernando Oliveira Justo, Pedro Paulo Luciano Afonso
Aug 8, 2021·Journal of Clinical Medicine·Pei-Kang LiuMing-Ju Tsai

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