Intravitreal Pharmacotherapies for Diabetic Macular Edema: A Report by the American Academy of Ophthalmology

Justis P. Ehlers, Steven Yeh, Maureen G. Maguire, Justine R. Smith, Prithvi Mruthyunjaya, Nieraj Jain, Leo A. Kim, Christina Y. Weng, Christina J. Flaxel, Scott D. Schoenberger, Stephen J. Kim

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To review the evidence on the safety and efficacy of current anti-vascular endothelial growth factor (VEGF) and intravitreal corticosteroid pharmacotherapies for the treatment of diabetic macular edema (DME). Methods: Literature searches were last conducted on May 13, 2020, in the PubMed database with no date restrictions and limited to articles published in English. The combined searches yielded 230 citations, of which 108 were reviewed in full text. Of these, 31 were deemed appropriate for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. Results: Only the 21 articles with level I evidence were included in this assessment. Seventeen articles provided level I evidence for 1 or more anti-VEGF pharmacotherapies, including ranibizumab (14), aflibercept (5), and bevacizumab (2) alone or in combination with other treatments for DME. Level I evidence was identified in 7 articles on intravitreal corticosteroid therapy for treatment of DME: triamcinolone (1), dexamethasone (4), and fluocinolone acetonide (2). Conclusions: Review of the available literature indicates that intravitreal injections of anti-VEGF agents and corticosteroids are efficacious treatments for DME. Elevated intraocular pressure and cataract progression are important potential complications of corticosteroid therapy. Further evidence is required to assess the comparative efficacy of these therapies. Given the limited high-quality comparative efficacy data, choice of therapy must be individualized for each patient and broad therapeutic access for patients is critical to maximize outcomes.

Original languageEnglish
Number of pages12
JournalOphthalmology
Early online date23 Aug 2021
DOIs
Publication statusE-pub ahead of print - 23 Aug 2021

Keywords

  • aflibercept
  • anti-VEGF therapies
  • bevacizumab
  • cataracts
  • corticosteroids
  • dexamethasone implant
  • diabetic macular edema
  • fluocinolone acetonide
  • hyperglycemia
  • ranibizumab

Fingerprint

Dive into the research topics of 'Intravitreal Pharmacotherapies for Diabetic Macular Edema: A Report by the American Academy of Ophthalmology'. Together they form a unique fingerprint.

Cite this