Focusing on the diagnosis and treatment of diabetic macular edema_Chinese Journal of Ocular Fundus Diseases

Authors：

 Xu Xun , Lu Yi

Department of Ophthalmology, The First People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai 200080, China;

Corresponding author：

Xu Xun, Email: drxuxun@sjtu.edu.cn

Keywords：

Macular edema/diagnosis; Macular edema/therapy; Diabetic retinopathy/ complications; Editorial

DOI：

10.3760/cma.j.issn.1005-1015.2018.04.001

Video：

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Diabetic macular edema (DME) is the main cause of visual impairment in diabetic retinopathy patients. It mainly includes focal DME and diffuse DME, while DME of clinical significance needs timely intervention treatment. Optical coherence tomography is currently recognized as the most sensitive method to accurately diagnose DME. Currently, the common treatments of DME include intravitreal injection of anti-vascular endothelial growth factor (VEGF) or glucocorticoid and laser photocoagulation. Among them, anti-VEGF injection is becoming the first-line therapeutic, and corresponding individual treatment or combined treatment strategy should be selected according to the characteristics of DME and the specific conditions of patients. During the diagnosis and treatment of DME, attention should be paid to the systemic treatment of diabetes and the effect of diabetes-related neuroretinopathy on the therapeutic effect of DME. With the appearance of heterogeneity in the efficacy of anti-VEGF drugs, it remains to be further studied how to choose alternative therapeutics and when to replace them.

Citation： Xu Xun, Lu Yi. Focusing on the diagnosis and treatment of diabetic macular edema. Chinese Journal of Ocular Fundus Diseases, 2018, 34(4): 313-316. doi: 10.3760/cma.j.issn.1005-1015.2018.04.001 Copy

1.	Engerman RL. Pathogenesis of diabetic retinopathy[J]. Diabetes, 1989, 38(10): 1203-1206.
2.	中华医学会眼科学分会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2014年)[J]. 中华眼科杂志, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. Guidelines for clinical diagnosis and treatment of diabetic retinopathy in China(2014)[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014. DOI: 10.3760/cma.j.issn.0412-4081.2013.09.005.
3.	黎晓新. 学习推广中国糖尿病视网膜病变防治指南, 科学规范防治糖尿病视网膜病变[J]. 中华眼底病杂志, 2015, 31(2): 117-120. DOI: 10.3760/cma.j.issn.1005-1015.2015.02.002.Li XX. Following the Chinese guideline of diabetic retinopathy in our practice[J]. Chin J Ocul Fundus Dis,2015, 31(2): 117-120. DOI: 10.3760/cma.j.issn.1005-1015.2015.02.002.
4.	Guariguata L. Contribute data to the 6th edition of the IDF Diabetes Atlas[J]. Diabetes Res Clin Pract, 2013, 100(2): 280-281. DOI: 10.1016/j.diabres.2013.02.006.
5.	Goebel W, Franke R. Retinal thickness in diabetic retinopathy: comparison of optical coherence tomography, the retinal thickness analyzer, and fundus photography[J]. Retina, 2006, 26(1): 49-57.
6.	唐皓, 徐延山, 张红, 等. 糖尿病性黄斑水肿的药物治疗进展[J]. 中华眼底病杂志, 2010, 3: 194-197. DOI: 10.3760/cma.j.issn.1005-1015.2010.02.31.Tang H, Xu YS, Zhang H, et al. Advances in drug treatment of diabetic macular edema[J]. Chin J Ocul Fundus Dis, 2010, 3: 194-197. DOI: 10.3760/cma.j.issn.1005-1015.2010.02.31.
7.	Massin P, Bandello F, Garweg JG, et al. Safety and efficacy of ranibizumab in diabetic macular edema (RESOLVE Study): a 12-month, randomized, controlled, double-masked, multicenter phase Ⅱ study[J]. Diabetes Care, 2010, 33(11): 2399-2405. DOI: 10.2337/dc10-0493.
8.	Lang GE, Berta A, Eldem BM, et al. Two-year safety and efficacy of ranibizumab 0.5 mg in diabetic macular edema: interim analysis of the RESTORE extension study[J]. Ophthalmology, 2013, 120(10): 2004-2012. DOI: 10.1016/j.ophtha.2013.02.019.
9.	Wang H, Sun X, Liu K, et al. Intravitreal ranibizumab (lucentis) for the treatment of diabetic macular edema: a systematic review and meta-analysis of randomized clinical control trials[J]. Curr Eye Res, 2012, 37(8): 661-670. DOI: 10.3109/02713683.2012.675616.
10.	Nguyen QD, Shah SM, Khwaja AA, et al. Two-year outcomes of the ranibizumab for edema of the mAcula in diabetes (READ-2) study[J]. Ophthalmology, 2010, 117(11): 2146-2151. DOI: 10.1016/j.ophtha.2010.08.016.
11.	Mitchell P, Bandello F, Schmidt-Erfurth U, et al. The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema[J]. Ophthalmology, 2011, 118(4): 615-625. DOI: 10.1016/j.ophtha.2011.01.031.
12.	Korobelnik JF, Do DV, Schmidt-Erfurth U, et al. Intravitreal aflibercept for diabetic macular edema[J]. Ophthalmology, 2014, 121(11): 2247-2254. DOI: 10.1016/j.ophtha.2014.05.006.
13.	Diabetic Retinopathy Clinical Research N, Wells JA, Glassman AR, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema[J]. N Engl J Med 2015, 372(13): 1193-1203. DOI: 10.1056/NEJMoa1414264.
14.	Wells JA, Glassman AR, Ayala AR, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema: two-year results from a comparative effectiveness randomized clinical trial[J]. Ophthalmology, 2016, 123(6): 1351-1359. DOI:10.1016/j.ophtha.2016.02.022.
15.	Romero-Aroca P, Baget-Bernaldiz M, Pareja-Rios A, et al. Diabetic macular edema pathophysiology: vasogenic versus inflammatory[J/OL]. J Diabetes Res, 2016, 2016: 2156273 [2016-09-28]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5059543/. DOI: 10.1155/2016/2156273.
16.	Diabetic Retinopathy Clinical Research N, Googe J, Brucker AJ, et al. Randomized trial evaluating short-term effects of intravitreal ranibizumab or triamcinolone acetonide on macular edema after focal/grid laser for diabetic macular edema in eyes also receiving panretinal photocoagulation[J]. Retina, 2011, 31(6): 1009-1027. DOI: 10.1097/IAE.0b013e318217d739.
17.	Boyer DS, Yoon YH, Belfort R Jr, et al. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema[J]. Ophthalmology, 2014, 121(10): 1904-1914. DOI: 10.1016/j.ophtha.2014.04.024.
18.	Campochiaro PA, Brown DM, Pearson A, et al. Sustained delivery fluocinolone acetonide vitreous inserts provide benefit for at least 3 years in patients with diabetic macular edema[J]. Ophthalmology, 2012, 119(10): 2125-2132. DOI: 10.1016/j.ophtha.2012.04.030.
19.	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[J]. Arch Ophthalmol, 1995, 113 (9): 1144-1155.

1. Engerman RL. Pathogenesis of diabetic retinopathy[J]. Diabetes, 1989, 38(10): 1203-1206.
2. 中华医学会眼科学分会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2014年)[J]. 中华眼科杂志, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. Guidelines for clinical diagnosis and treatment of diabetic retinopathy in China(2014)[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014. DOI: 10.3760/cma.j.issn.0412-4081.2013.09.005.
3. 黎晓新. 学习推广中国糖尿病视网膜病变防治指南, 科学规范防治糖尿病视网膜病变[J]. 中华眼底病杂志, 2015, 31(2): 117-120. DOI: 10.3760/cma.j.issn.1005-1015.2015.02.002.Li XX. Following the Chinese guideline of diabetic retinopathy in our practice[J]. Chin J Ocul Fundus Dis,2015, 31(2): 117-120. DOI: 10.3760/cma.j.issn.1005-1015.2015.02.002.
4. Guariguata L. Contribute data to the 6th edition of the IDF Diabetes Atlas[J]. Diabetes Res Clin Pract, 2013, 100(2): 280-281. DOI: 10.1016/j.diabres.2013.02.006.
5. Goebel W, Franke R. Retinal thickness in diabetic retinopathy: comparison of optical coherence tomography, the retinal thickness analyzer, and fundus photography[J]. Retina, 2006, 26(1): 49-57.
6. 唐皓, 徐延山, 张红, 等. 糖尿病性黄斑水肿的药物治疗进展[J]. 中华眼底病杂志, 2010, 3: 194-197. DOI: 10.3760/cma.j.issn.1005-1015.2010.02.31.Tang H, Xu YS, Zhang H, et al. Advances in drug treatment of diabetic macular edema[J]. Chin J Ocul Fundus Dis, 2010, 3: 194-197. DOI: 10.3760/cma.j.issn.1005-1015.2010.02.31.
7. Massin P, Bandello F, Garweg JG, et al. Safety and efficacy of ranibizumab in diabetic macular edema (RESOLVE Study): a 12-month, randomized, controlled, double-masked, multicenter phase Ⅱ study[J]. Diabetes Care, 2010, 33(11): 2399-2405. DOI: 10.2337/dc10-0493.
8. Lang GE, Berta A, Eldem BM, et al. Two-year safety and efficacy of ranibizumab 0.5 mg in diabetic macular edema: interim analysis of the RESTORE extension study[J]. Ophthalmology, 2013, 120(10): 2004-2012. DOI: 10.1016/j.ophtha.2013.02.019.
9. Wang H, Sun X, Liu K, et al. Intravitreal ranibizumab (lucentis) for the treatment of diabetic macular edema: a systematic review and meta-analysis of randomized clinical control trials[J]. Curr Eye Res, 2012, 37(8): 661-670. DOI: 10.3109/02713683.2012.675616.
10. Nguyen QD, Shah SM, Khwaja AA, et al. Two-year outcomes of the ranibizumab for edema of the mAcula in diabetes (READ-2) study[J]. Ophthalmology, 2010, 117(11): 2146-2151. DOI: 10.1016/j.ophtha.2010.08.016.
11. Mitchell P, Bandello F, Schmidt-Erfurth U, et al. The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema[J]. Ophthalmology, 2011, 118(4): 615-625. DOI: 10.1016/j.ophtha.2011.01.031.
12. Korobelnik JF, Do DV, Schmidt-Erfurth U, et al. Intravitreal aflibercept for diabetic macular edema[J]. Ophthalmology, 2014, 121(11): 2247-2254. DOI: 10.1016/j.ophtha.2014.05.006.
13. Diabetic Retinopathy Clinical Research N, Wells JA, Glassman AR, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema[J]. N Engl J Med 2015, 372(13): 1193-1203. DOI: 10.1056/NEJMoa1414264.
14. Wells JA, Glassman AR, Ayala AR, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema: two-year results from a comparative effectiveness randomized clinical trial[J]. Ophthalmology, 2016, 123(6): 1351-1359. DOI:10.1016/j.ophtha.2016.02.022.
15. Romero-Aroca P, Baget-Bernaldiz M, Pareja-Rios A, et al. Diabetic macular edema pathophysiology: vasogenic versus inflammatory[J/OL]. J Diabetes Res, 2016, 2016: 2156273 [2016-09-28]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5059543/. DOI: 10.1155/2016/2156273.
16. Diabetic Retinopathy Clinical Research N, Googe J, Brucker AJ, et al. Randomized trial evaluating short-term effects of intravitreal ranibizumab or triamcinolone acetonide on macular edema after focal/grid laser for diabetic macular edema in eyes also receiving panretinal photocoagulation[J]. Retina, 2011, 31(6): 1009-1027. DOI: 10.1097/IAE.0b013e318217d739.
17. Boyer DS, Yoon YH, Belfort R Jr, et al. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema[J]. Ophthalmology, 2014, 121(10): 1904-1914. DOI: 10.1016/j.ophtha.2014.04.024.
18. Campochiaro PA, Brown DM, Pearson A, et al. Sustained delivery fluocinolone acetonide vitreous inserts provide benefit for at least 3 years in patients with diabetic macular edema[J]. Ophthalmology, 2012, 119(10): 2125-2132. DOI: 10.1016/j.ophtha.2012.04.030.
19. 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[J]. Arch Ophthalmol, 1995, 113 (9): 1144-1155.

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