Avinoam Ophir*

Ophthalmology Center, Ramat-Hasharon, Israel

*Corresponding Author: Avinoam Ophir, Ophthalmology Center, Ramat-Hasharon, Israel.

Received: April 22, 2024; Published: May 01, 2024

Abstract

In diabetic macular edema (DME), the longer the edema the greater macular layers injury and visual acuity (VA) loss [1-4]. Therefore the primary aim of DME therapy is to achieve early, long-lasting dry macula in order to improve or sustain VA. The basic pre-condition for achieving an efficacious therapy is to treat the pathogenesis. The recent line of DME pathogeneses is as follows: A) macular microaneurysms (MAs), which arise secondary to hypoxic state in the neurosensory retina and are considered the hallmark of “focal” DME [5]. In the past, focal laser photocoagulation of individual leaky MA was the standard of care, but outcomes were limited.

References

1. Sadda SR., et al. “Relationship between duration and extent of edema and visual acuity outcome with ranibizumab in diabetic macular edema: A post hoc analysis of Protocol I data”. Eye (London) 34 (2020): 480-490.
2. Sakamoto A., et al. “Association between foveal photoreceptor status and visual acuity after resolution of diabetic macular edema by pars plana vitrectomy”. Graefe’s Archives Clinical Experimental Ophthalmology 247 (2009): 1325-1330.
3. Cennamo G., et al. “Evaluation of vessel density in disorganization of retinal inner layers after resolved diabetic macular edema using optical coherence tomography”. PLoS One 16 (2021): 0244789.
4. Schmidt-Erfurth U., et al. “Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA)”. Ophthalmologica 237 (2017): 185-222.
5. Early Treatment Diabetic Retinopathy Study Research Group. “Focal photocoagulation treatment of diabetic macular edema. Relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseline: ETDRS report No. 19”. Archives Ophthalmology 113 (1995): 1144-1155.
6. Lee SN., et al. “Characterization of microaneurysm closure after focal laser photocoagulation in diabetic macular edema”. American Journal of Ophthalmology 155 (2013): 905-912.e2.
7. Nozaki M., et al. “The Role of Laser Photocoagulation in Treating Diabetic Macular Edema in the Era of intravitreal Drug Administration: A Descriptive Review”. Medicina 59 (2023): 1319.
8. Tanaka H., et al. “A new surgical approach for the treatment of a refractory foveal microaneurysm: A case report”. American Journal Ophthalmology Case Reports 34 (2024) 102034.
9. Takamura Y., et al. “Turnover of Microaneurysms After Intravitreal Injections of Faricimab for Diabetic Macular Edema”. Investigative Ophthalmology Visual Sciences 64 (2023): 31.
10. Sawa M. “Two cases of diabetic macular edema with diminished areas of retinal non-perfusion and microaneurysms after intravitreal faricimab injections”. American Journal Ophthalmology Case Reports 33 (2024): 101973.
11. Ophir A., et al. “Vitreous traction and epiretinal membranes in diabetic macular edema using spectral-domain optical coherence tomography”. Eye (London) 24 (2010): 1545-1553.
12. Adhi M., et al. “Three-dimensional enhanced imaging of vitreoretinal interface in diabetic retinopathy using swept-source optical coherence tomography”. American Journal Ophthalmology 162 (2016): 140-149.
13. Fatima N., et al. “Frequency of vitreomacular traction in diabetic macular edema on optical coherence tomography”. Pakistan Armed Forces Medical Journal 67 (2017): 47-50.
14. Karatas M., et al. “Diabetic vitreopapillary traction and macular edema”. Eye (London) 19 (2005): 676-682.
15. Ophir A Re Mylonas G., et al. “The impact of the vitreomacular interface on functional and anatomical outcomes in diabetic macular edema treated with three different anti-VEGF agents: Post hoc analysis of the protocol T study”. Correspondence”. Retina 43 (2023): e39-41.
16. Ophir A. “Achieving durable dry macula in diffuse diabetic macular edema: A meta-analysis”. Acta Scientific Ophthalmology3 (2021): 91-104.
17. Hagenau F., et al. “Vitrectomy for diabetic macular edema: Optical coherence tomography criteria and pathology of the vitreomacular interface”. American Journal Ophthalmology 200 (2019): 34-46.
18. Jones CH., et al. “Hyalocytes in proliferative vitreoretinal diseases”. Expert Review Ophthalmology 22 (2022): 263-280.
19. Elman MJ., et al. “Expanded 2-year follow-up of ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema”. Ophthalmology 118 (2011): 609-614.
20. Mitchell P., et al. “The RESTORE Study: Ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema”. Ophthalmology 118 (2011): 615-
21. Diabetic Retinopathy Clinical Research Network; Wells JA., et al. “Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema”. New England Journal Medicine 372 (2015): 1193-1203.
22. Glassman AR., et al. “Five-Year Outcomes after initial Aflibercept, Bevacizumab, or Ranibizumab treatment for diabetic macular edema (Protocol T Extension Study)”. Ophthalmology 127 (2020): 1201-1210.
23. Jhaveri CD., et al. “Aflibercept monotherapy or bevacizumab first for diabetic macular edema”. New England Journal Medicine 387 (2022): 692-703.
24. Arevalo JF., et al. “Pan-American Collaborative Retina Study Group (PACORES). “Intravitreal bevacizumab plus grid laser photocoagulation or intravitreal bevacizumab or grid laser photocoagulation for diffuse diabetic macular edema”. Retina 33 (2013): 403-413.
25. Ophir A. “Full-field 3-D optical coherence tomography imaging and treatment decision in diffuse diabetic macular edema”. Investigative Ophthalmology Visual Science 55 (2014): 3052-3053.
26. La Haij , et al. “Vitrectomy results in diabetic macular edema without evident vitreomacular traction”. Graefe’s Archives Clinical Experimental Ophthalmology 239 (2001): 264-270.
27. Yanyali A., et al. “Modified grid laser photocoagulation versus pars plana vitrectomy with internal limiting membrane removal in diabetic macular edema”. American Journal of Ophthalmology 139 (2005): 795-801.
28. Iglicki M., et al. “Biomarkers and predictors for functional and anatomic outcomes for small gauge pars plana vitrectomy and peeling of the internal limiting membrane in naïve diabetic macular edema: The VITAL Study”. PloS One7 (2018).
29. Michalewska Z., et al. “Vitrectomy in the management of diabetic macular edema in treatment-naïve patients”. Canadian Journal Ophthalmology 53 (2018): 402-407.
30. Flaxel CJ., et al. “Factors associated with visual acuity outcomes after vitrectomy for diabetic macular edema: Diabetic Retinopathy Clinical Research network”. Retina 30 (2010): 1488-1495.
31. Ophir A., et al. “Importance of 3-D image reconstruction of spectral-domain OCT on outcome of grid laser photocoagulation for diffuse diabetic macular edema”. International Journal Ophthalmology 6 (2013): 836-843.
32. Stefansson E., et al. “Increased retinal oxygen supply following pan-retinal photocoagulation and vitrectomy and lensectomy”. Transactions American Ophthalmology Society 79 (1981): 307-334.
33. Sebag J. “Vitreoschisis”. Graefe’s Archives Clinical Experimental Ophthalmology 246 (2008): 329-332.
34. Ophir A and Martinez MR. “Epiretinal membranes and incomplete posterior vitreous detachment in diabetic macular edema detected by spectral-domain optical coherence tomography”. Investigative Ophthalmology Visual Sciences 52 (2011): 6414-6420.
35. Ophir A., et al. “Extrafoveal vitreous traction associated with branch retinal vein occlusion”. European Journal Ophthalmology 20 (2010): 733-739.
36. Kong K. “Progression Patterns of Myopic Traction Maculopathy in the Fellow Eye After Pars Plana Vitrectomy of the Primary Eye”. Investigative Ophthalmology Visual Science 62 (2021):
37. Ilse Krebs., et al. “Spectral domain optical coherence tomography for higher precision in the evaluation of vitreoretinal adhesions in exudative age-related macular degeneration”. British Journal of Ophthalmology 95 (2011): 1415-1418.
38. Wykoff CC., et al. “Efficacy, durability, and safety of intravitreal faricimab with extended dosing up to every 16 weeks in patients with diabetic macular oedema (YOSEMITE and RHINE): two randomised, double-masked, phase 3 trials”. Lancet 399 (2022): 741-755.
39. Wong TY., et al. “Faricimab Treat-and-Extend for Diabetic Macular Edema: Two-Year Results from the Randomized Phase 3 YOSEMITE and RHINE Trials”. Ophthalmology (2023). S0161-6420.
40. Rush RB. “One Year Results of Faricimab for Aflibercept-Resistant Diabetic Macular Edema”. Clinical Ophthalmology 17 (2023): 2397-2403.
41. Brown DM, et al. “Intravitreal aflibercept 8 mg in diabetic macular oedema (PHOTON): 48-week results from a randomised, double-masked, non-inferiority, phase 2/3 trial”. Lancet 403 (2024): 1153-1163.
42. Guymer R., et al. “Rationale and Design of VOYAGER: Longterm Outcomes of Faricimab and Port Delivery System with Ranibizumab for Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema in Clinical Practice”. Ophthalmology Science 4 (2024): 100442.

Citation

Citation: Avinoam Ophir. “Diabetic Macular Edema: Approaching a Curative Situation".Acta Scientific Ophthalmology 7.6 (2024): 01-05.

Copyright

Copyright: © 2024 Avinoam Ophir. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.