Posterior Segment Diabetic Macular Edema
Epidemiology of Diabetes Interventions and Complications Study (EDIC)38 showed that intensive glycemic control and blood pressure control delayed the onset of macular edema as compared with conventional treatment. Intensive glucose control had a sustained effect, with a 58% risk reduction in the development of DME in the DCCT patients. Therefore improved systemic management of diabetes will likely also have a preventive effect on the development of DME.
The future may include research to investigate the genetics of DME. The identification of patients who are susceptible to macular edema may
1. Klein R, Klein B, Moss S, et al., The Wisconsin Epidemiologic Study of Diabetic Retinopathy, IV: diabetic macular edema, Ophthalmology, 1984;91:1464–74.
2. Early Treatment Diabetic Retinopathy Study Research Group, Photocoagulation for diabetic macular edema: ETDRS report number 4, Int Ophthalmol Clin, 1987;27:265–72.
3. Early Treatment Diabetic Retinopathy Study Research Group, Photocoagulation for diabetic macular edema. Early treatment diabetic retinopathy study report number 1, Arch Ophthalmol, 1985;103:1796–1806.
4. Diabetic Retinopathy Clinical Research Network, Comparison of modified-ETDRS and mild macular grid laser photocoagulation strategies for diabetic macular edema, Arch Ophthalmol, 2007;125:469–80.
5. Rosenfeld P, Brown DM, Heier J, et al., Ranibizumab for neovascular age-related macular degeneration, N Engl J Med, 2006;355:1419–31.
6. Brown DM, Kaiser PK, Michels M, et al., Ranibizumab versus verteporfin for Neovascular age-related macular degeneration, N Engl J Med, 2006;355:1432–44.
7. Aiello LP, Avery RL, Arrigg PG, et al., Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders, N Engl J Med, 1994;331:1480–7.
8. Funatsu H, Yamashita H, Noma H, et al., Increased levels of vascular endothelial growth factor and interleukin-6 in the aqueous humor of diabetics with macular edema, Am J Ophthalmol, 2002;133:70–7.
9. Macugen Diabetic Retinopathy Study Group, A phase II randomized double-masked trial of pegaptanib, an anti- vascular endothelial growth factor aptamer, for diabetic macular edema, Ophthalmology, 2005;112:1747–57.
10. Diabetic Retinopathy Clinical Research Network, Scott IU, Edwards AR, et al., A phase II randomized clinical trial of intravitreal bevacizumab for diabetic macular edema, Ophthalmology, 2007;114:1860–7.
11. Ahmadieh H, Ramezani A, Shoeibi N, et al., Intravitreal bevacizumab with or without triamcinolone for refractory diabetic macular edema; a placebo-controlled, randomized clinical trial, Graefes Arch Clin Exp Ophthalmol, 2008;246:483–9.
12. Shimura M, Nakazawa T, Yasuda K, et al., Comparative therapy evaluation of intravitreal bevacizumab and triamcinolone acetonide on persistent diffuse diabetic macular edema, Am J Ophthalmol, 2008;145(5):854–61.
13. Wu L, Martínez-Castellanos MA, Quiroz-Mercado H, et al., Twelve-month safety of intravitreal injections of bevacizumab (Avastin): results of the Pan-American Collaborative Retina Study Group (PACORES), Graefes Arch Clin Exp Ophthalmol, 2008;246(1):81–7.
14. Chun DW, Heier JS, Topping TM, et al., A pilot study of multiple
enable more preventive therapies to that population. Identification of genetic variants in the complement system has been possible in AMD. Similar work in macular edema may be useful.
Thus, there are several research pathways to pursue that may yield improvements in our ability to manage DME and, perhaps more importantly, prevent its development. I am hopeful that scientists and drug companies will continue to focus upon some of these pathways and that some of these efforts will yield a fruitful harvest of new treatments for DME. n
intravitreal injections of ranibizumab in patients with center- involving clinically significant diabetic macular edema, Ophthalmology, 2006;113:1706–12.
15. Nguyen QD, Tatlipinar S, Shah SM, et al., Vascular endothelial growth factor is a critical stimulus for diabetic macular edema, Am J Ophthalmol, 2006;142:961–9.
16. Do DV, Nguyen QD, Heier JS, et al., Six-month results of the READ-2 Study: Ranibizumab for edema of the macula in diabetes. A phase II clinical trial. Presented at American Society of Retinal Specialists Annual Meeting, October 13, 2008, Maui, HI.
17. Nguyen QD, Shah SM, Heier J, et al; READ-2 Study Group, Two- year outcomes of the Ranibizumab for Edema of the mAcula in Diabetes (READ-2) Study, Ophthalmology, 2010;117(11):2146–51.
18. Elman MJ, Aiello LP, Beck RW, et al., Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema, Ophthalmology, 2010;117(6):1064–77.
19. Singerman LJ, Reich S, O’Shaughnessy D, et al., Bevasiranib for treatment of age-related macular degeneration and diabetic macular edema. Presented at Retina Society 40th Annual Scientific Meeting, September 28, 2007, Boston, MA.
20. Nguyen QD, Shah SM, Hafiz G, et al., A phase I trial of an IV-administered vascular endothelial growth factor trap for treatment in patients with choroidal neovascularization due to age-related macular degeneration, Ophthalmology, 2006;113:1522–32.
21. Jonas JB, Kreissig I, Sofker A, Degenring RF, Intravitreal injection of triamcinolone for diffuse macular edema, Arch Ophthalmol, 2003;121:57–61.
22. Gillies MC, Sutter FK, Simpson JM, et al., Intravitreal triamcinolone for refractory diabetic macular edema: two-year results of a double-masked, placebo-controlled, randomized clinical trial, Ophthalmology, 2006;113:1533–8.
23. Zhang X, Bao S, Lai D, et al., Intravitreal triamcinolone acetonide inhibits breakdown of the blood-retinal barrier through differential regulation of VEGF-A and its receptors in early diabetic rat retinas, Diabetes, 2008;57:1026–33.
24. Ip MS, Comstock T, Fluocinolone acetonide intravitreal implant to treat diabetic macular edema: 3-year results of a multicenter clinical trial. Presented at Retina Society/Club Jules Gonin Annual Meeting, Oct 15–20, 2006, Cape Town, South Africa.
25. Adamiec-Mroczek J, Oficjalska-Mlynczak J, Assessment of selected adhesion molecule and proinflammatory cytokine levels in the vitreous body of patients with type 2 diabetes – role of the inflammatory-immune process in the pathogenesis of proliferative diabetic retinopathy, Graefes Arch Clin Exp Ophthalmol, 2008;246:1665–70.
26. Combined approach to Treatment Using Ranibizumab and Efalizumab for Diabetic Macular Edema Study: The CAPTURE
DME Study. Available at:
www.clinicaltrials.gov (accessed August 28, 2008).
27. Takaya K, Suzuki Y, Mizutani H, et al., Long-term results of vitrectomy for removal of submacular hard exudates in patients with diabetic maculopathy, Retina, 2004;24:23–9.
28. Sakuraba T, Suzuki Y, Mizutani H, Nakazawa M, Visual improvement after removal of submacular exudates in patients with diabetic maculopathy, Ophthalmic Surg Lasers, 2000;31:287–91.
29. Gupta A, Gupta V, Thapar S, Bhansali A, Lipid-lowering drug atorvastatin as an adjunct in the management of diabetic macular edema, Am J Ophthalmol, 2004;137:675–82.
30. Lim JI, Spee C, Hinton D, Determination of HIF-1 in surgically excised preretinal membranes of diabetic patients compared to non-diabetic patients. Poster F-7. Presented at Retina Society 40th Annual Scientific Meeting, September 28, 2007, Boston, MA.
31. Blumenkranz MS, Dugel P, Solley WA, et al., Rapamycin (Sirolimus) for the treatment of diabetic macular edema: Preliminary results of a prospective phase 1 trial. Presented at Retina Society 40th Annual Scientific Meeting, September 28, 2007, Boston, MA.
32. Wheeler L, WoldeMussie E, Lai R, Role of alpha-2 agonists in neuroprotection, Surv Ophthalmol, 2003;48(Suppl. 1):S47–51.
33. Age-Related Eye Disease Study Research Group, A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8, Arch Ophthalmol, 2001;119:1417–36.
34. PKC-DRS Study Group, The effect of ruboxistaurin on visual loss in patients with moderately severe to very severe nonproliferative diabetic retinopathy: initial results of the Protein Kinase C beta Inhibitor Diabetic Retinopathy Study (PKC-DRS) multicenter randomized clinical trial, Diabetes, 2005;54(7):2188–97.
35. The PKC-DRS Study group, Effect of ruboxistaurin on visual loss in patients with diabetic retinopathy, Ophthalmology, 2006;113:2221–30.
36. Diabetes Control and Complication Trial Research Group, The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin- dependent diabetes mellitus, N Engl J Med, 1993;329:977–86.
37. UK Prospective Diabetes Study Group, Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. UKPDS 33, Lancet, 1998;352:837–53.
38. The Diabetes Control and Complication Trial/Epidemiology of Diabetes Interventions and Complications Research Group, Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy, N Engl J Med, 2000;342:381–9.
104
US OPHTHALMIC REVIEW
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116