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Guidelines for the Management of Center-Involving Diabetic Macular Edema: Treatment Options and Patient Monitorization

2021Journal article Open access
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dc.contributor.authorFigueira, J
dc.contributor.authorHenriques, J
dc.contributor.authorCarneiro, A
dc.contributor.authorMarques-Neves, C
dc.contributor.authorFlores, R
dc.contributor.authorCastro-Sousa, JP
dc.contributor.authorMeireles, A
dc.contributor.authorGomes, N
dc.contributor.authorNascimento, J
dc.contributor.authorAmaro, M
dc.contributor.authorSilva, R
dc.date.accessioned2022-05-20T14:44:28Z
dc.date.available2022-05-20T14:44:28Z
dc.date.issued2021
dc.description.abstractDiabetic macular edema (DME) is the main cause of visual impairment associated with diabetic retinopathy (DR) and macular laser, during approximately three decades, and was the single treatment option. More recently, intravitreous injections of anti-angiogenics and corticosteroids modified the treatment paradigm associated with significant vision improvements. Nevertheless, not all patients respond satisfactorily to anti-VEGF or corticosteroid injections, so an adequate treatment choice and a prompt switch in therapeutic class is recommended. Several algorithms and guidelines have been proposed for treating center involving DME to improve patients' vision and quality of life. However, in Portugal, such guidelines are lacking. The present review aimed to provide guidelines for the treatment options and patient monitorization in the management of center-involving DME. We recommend anti-vascular endothelial growth factor (VEGF) as first-line therapy after a clinical evaluation accompanied by a rigorous metabolic control. Depending on the response obtained after 3-6 monthly intravitreal injections we suggest switching outside the class in case of a non-responder, maintaining the anti-VEGF-therapy in responders to anti-angiogenics. The treatment regimen for Dexamethasone intravitreal implant (DEXii) should be pro-re-nata with bi-monthly or quarterly monitoring visits (with a scheduled visit at 6-8 weeks after DEXii for intraocular pressure control). If a patient does not respond to DEXii, switch again to anti-VEGF therapy, combine therapies, or re-evaluate patients diagnose. There is a resilient need to understand the disease, its treatments, regimens available, and convenience for all involved to propose an adequate algorithm for the treatment of diabetic retinopathy (DR) and DME in an individualized regimen. Further understanding of the contributing factors to the development and progression of DR should bring new drug discoveries for more effective and better-tolerated treatments.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationClin Ophthalmol. 2021 Jul 30;15:3221-3230.pt_PT
dc.identifier.doi10.2147/OPTH.S318026.pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/4088
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherDove Presspt_PT
dc.subjectHSAC OFTpt_PT
dc.subjectAnti-Vascular Endothelial Growth Factorpt_PT
dc.subjectCenter-Involving Diabetic Macular Edemapt_PT
dc.subjectDexamethasone Intravitreal Implantpt_PT
dc.subjectDiabetic Retinopathypt_PT
dc.titleGuidelines for the Management of Center-Involving Diabetic Macular Edema: Treatment Options and Patient Monitorizationpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage3230pt_PT
oaire.citation.startPage3221pt_PT
oaire.citation.titleClinical Ophthalmologypt_PT
oaire.citation.volume15pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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