Intravitreal injections of anti-vascular endothelial growth factor (VEGF) and intravitreal corticosteroid pharmacotherapies are efficacious treatments for patients with diabetic macular edema (DME), according to study results published in Ophthalmology.

A team of investigators for the American Academy of Ophthalmology conducted a literature review to assess the evidence and safety of current intravitreal anti-VEGF and intravitreal corticosteroid therapies for the management of DME. 

Of the 31 articles that were appropriate for inclusion, 21 articles with level 1 evidence were included in the review. A total of 17 articles provided level 1 evidence for 1 or more anti-VEGF pharmacotherapies such as ranibizumab, aflibercept, and bevacizumab either alone or in combination with another treatment for DME. In addition, 7 articles with level 1 evidence on intravitreal corticosteroid therapy with triamcinolone, dexamethasone, and fluocinolone acetonide were included in the analysis. 


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The overall ocular safety profile of anti-VEGF therapeutics was tolerable and suggested low rates of adverse events that threatened vision such as intraoculation inflammation (1.4%-2.9%), endophthalmitis (0.019%-1.6%), and retinal detachment (0%-0.67%) according to several of the trials included in the review. Data on the long-term increase in intraocular pressure (IOP) following anti-VEGF therapy varies and may require additional research, the researchers report. The most frequently encountered ocular adverse effects of corticosteroids is cataract formation and increased IOP. 

The authors note the need for additional evidence to determine the comparative efficacy of these therapies. Because of the limitations in high-quality data to compare efficacy of these treatment options, the choice of therapy should be individualized per patient and broad therapeutic access is essential for the maximization of outcomes in patients with DME, according to the researchers  

“Further investigations with imaging modalities that include color fundus photography, [optical coherence tomography] and [optical coherence tomography] angiography, and ultra-widefield fluorescein angiography are needed to interpret the role of current drugs in patient-tailored approaches to DME management and prognosis,” the authors explain. 

“Emerging therapies, including combination therapeutics, new anti-VEGF molecules, new drugs with alternative biological targets, novel delivery platforms, gene therapy, and combination therapeutics, may also impact the future treatment approach to DME,” the study says. 

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures. 

Reference 


Ehlers JP, Yeh S, Maguire MG, et al. Intravitreal pharmacotherapies for diabetic macular edema: a report by the American Academy of Ophthalmology. Ophthalmol. Published online August 23, 2021. doi:10.1016/j.ophtha.2021.07.009