Journal
OPHTHALMOLOGY
Volume 129, Issue 1, Pages 88-99Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.ophtha.2021.07.009
Keywords
diabetic macular edema; ranibizumab; bevacizumab; anti-VEGF therapies; corticosteroids; dexamethasone implant; fluocinolone acetonide; cataracts; hyperglycemia; aflibercept
Categories
Funding
- American Academy of Ophthalmology
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Evidence review suggests that anti-VEGF agents and corticosteroids are effective treatments for diabetic macular edema, but corticosteroid therapy may lead to elevated intraocular pressure and cataract progression. Further research is needed to compare the efficacy of these therapies and individualized treatment choices are essential for optimal outcomes.
Purpose: To review the evidence on the safety and efficacy of current anti-vascular endothelial growth factor (VEGF) and intravitreal corticosteroid pharmacotherapies for the treatment of diabetic macular edema (DME). Methods: Literature searches were last conducted on May 13, 2020, in the PubMed database with no date restrictions and limited to articles published in English. The combined searches yielded 230 citations, of which 108 were reviewed in full text. Of these, 31 were deemed appropriate for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. Results: Only the 21 articles with level I evidence were included in this assessment. Seventeen articles provided level I evidence for 1 or more anti-VEGF pharmacotherapies, including ranibizumab (14), aflibercept (5), and bevacizumab (2) alone or in combination with other treatments for DME. Level I evidence was identified in 7 articles on intravitreal corticosteroid therapy for treatment of DME: triamcinolone (1), dexamethasone (4), and fluocinolone acetonide (2). Conclusions: Review of the available literature indicates that intravitreal injections of anti-VEGF agents and corticosteroids are efficacious treatments for DME. Elevated intraocular pressure and cataract progression are important potential complications of corticosteroid therapy. Further evidence is required to assess the comparative efficacy of these therapies. Given the limited high-quality comparative efficacy data, choice of therapy must be individualized for each patient and broad therapeutic access for patients is critical to maximize outcomes. (C) 2021 by the American Academy of Ophthalmology
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