Edema macular diabético

Diabetic Macular Edema

Table of Contents

Diabetic Macular Edema

Diabetic macular edema (DME) is the most frequent cause of vision loss in patients with diabetes and is an important public health problem. An estimated 425 million people are affected by diabetes worldwide in 2017 (IDF Atlas Eighth Edition 2017),  and the number of people with diabetes is expected to double from 2005 to 2030.

The pathogenesis of diabetic macular edema is multifactorial, and several therapeutic modalities have been proposed for the treatment of diabetic macular edema. Recent clinical trials show the improved visual acuity and macular swelling, and currently antivascular endothelial growth factor (VEGF) therapy has become the first line of treatment of diabetic macular edema. Sometimes, these eyes with diabetic macular edema may be refractory to anti-VEGF, fortunately the advancing technology and new forms of therapies using corticosteroids, laser, and vitrectomy can be alternative tools for the persistent or refractory anti-VEGF drugs.

Optica coherence tomography (OCT) in a patient with diabetic macular edema
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The Wisconsin Epidemiologic Study of Diabetic Retinopathy found the 14-year incidence of DME in type I diabetics to be 26%. Similarly the Diabetes Control and Complications Trial (DCCT) reported that 27% of type I diabetic patients develop DME within 9 years of onset. An even higher incidence of macular edema has been reported in older patients with type 2 diabetes.

For patients with center involved macular edema, the risk of moderate vision loss at 3 years remained 15% with treatment. Since the publication of ETDRS, the DCCT and United Kingdom Prospective Diabetes Study (UKPDS) have demonstrated that tight glycemic and blood pressure control decrease the risk of microvascular complications of diabetes, including Diabetic Retinopathy and vision loss.

Within the last 10 years, the use of intravitreal corticosteroids and intravitreal anti-vascular endothelial growth factor (VEGF) agents have come into common clinical practice for the management of diabetic macular edema and several recent randomized clinical trials have shown improved effectiveness of Anti-VEGF compared to focal/grid laser.

Proliferative diabetic retinopathy and macular edema
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At Retina Center we have experience in the use of anti-vegf and intravitreal steroids to treat macular edema. We are also developing clinical trials with good results with new medications at a more affordable cost. We currently have a clinical trial with more than 60 patients, with a 2-year follow-up with excellent results.

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