1
|
Boscia F, Veritti D, Iaculli C, Lattanzio R, Freda S, Piergentili B, Varano M. Management of treatment-naïve diabetic macular edema patients: Review of real-world clinical data. Eur J Ophthalmol 2024:11206721241237069. [PMID: 38462923 DOI: 10.1177/11206721241237069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
The high prevalence of Diabetic macular edema (DME) is a real global health problem. Its complex pathophysiology involves different pathways. Over the last decade, the introduction of intravitreal treatments has dramatically changed the management and prognosis of DME. Among the different treatment options, inhibitors of vascular endothelial growth factor (anti-VEGF) and intravitreal steroids implants represent the first-line therapy of DME. We conducted a review of electronic databases to compile the available evidence about the clinical management of DME in a clinical setting, with a special focus on treatment-naïve patients. Anti-VEGF therapies represent a valuable option for treating DME patients. However, many patients do not respond properly to this treatment and, due to its administration regimen, many patients receive suboptimal treatment in real life. Current evidence demonstrated that in patients with DME, DEX-i improved significantly both anatomic and visual outcomes. Besides eyes with insufficient anti-VEGF respond or recalcitrant DME cases, DEX-i can be effectively and safely used in treatment-naïve DME patients as first line therapy. DEX-i may be considered first line therapy in different clinical scenarios, such as DME eyes with a greater inflammatory component, patients with cardiovascular events, vitrectomized eyes, or those requiring cataract surgery. In conclusion, there are still many points for improvement pending in the clinical management of the patient with DME. Since DME treatment must follow a patient-tailored approach, selecting the best therapeutic approach for each patient requires a good understanding of the pathophysiology of DME.
Collapse
Affiliation(s)
- Francesco Boscia
- Department of Translational Medicine and Neurosciences (DiBraiN), University of Bari, Bari, Italy
| | - Daniele Veritti
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Cristiana Iaculli
- Department of Ophthalmology, Policlinico Riuniti Di Foggia, University of Foggia, 71122, Foggia, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Freda
- AbbVie S.r.l., SR 148 Pontina, 04011, Campoverde, LT
| | | | - Monica Varano
- Ophthalmology Department, IRCCS - Fondazione Bietti, Rome, Italy
| |
Collapse
|
2
|
Kodjikian L, Baillif S, Couturier A, Creuzot-Garcher C, Delyfer MN, Matonti F, Weber M. Recommendations for the management of diabetic macular oedema with intravitreal dexamethasone implant: A national Delphi consensus study. Eur J Ophthalmol 2021; 32:2845-2856. [PMID: 34779302 DOI: 10.1177/11206721211052852] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE The intravitreal dexamethasone implant (DEX-I) is an alternative to anti-VEGF for the first-line treatment of diabetic macular oedema (DME). However, several questions remain regarding its routine use and its place in certain situations not always specified in current recommendations. A national consensus approach was, therefore, initiated by French retinal experts. METHODS An iterative Delphi consensus approach was used. A steering committee (SC) of seven experts analysed data from the literature to formulate statements divided into five key areas of treatment. These statements were submitted to the independent and anonymous electronic vote of 87 French retina experts among whom 39 expressed their opinion and therefore constituted the voting panel. RESULTS After two rounds of voting, 22 and 7 of 38 statements received a strong consensus and a good consensus, respectively. The consensus level was higher for statements regarding first-line indications and safety of DEX-I compared to those regarding efficacy assessment, reprocessing time or pathophysiological biomarkers. The panellists recommended the preferential use of DEX-I for patients with limited availability for multiple injections, those who needed to undergo cataract surgery or who had a recent cardiovascular history, and as a therapeutic alternative to anti-VEGF in patients with a history of vitrectomy, retinal serous detachment, hyper-reflective points or dry exudates in optical coherence tomography (OCT). However, some statements proposed by SC experts were not validated. CONCLUSION This study provides some key recommendations to clinicians treating diabetic macular oedema, which may be useful when using intravitreal dexamethasone implants in daily practice.
Collapse
Affiliation(s)
- Laurent Kodjikian
- 386696Hospital La Croix-Rousse Ophthalmology, Lyon, Rhône-Alpes, France
| | - Stephanie Baillif
- Department of Ophthalmology, 37045Centre Hospitalier Universitaire de Nice, Nice, France
| | - Aude Couturier
- Department of Ophthalmology, 378772Hospital Lariboisière, Paris, Île-de-France, France
| | | | | | - Frédéric Matonti
- Centre Monticelli Paradis, Marseille, France.,Aix Marseille University, Marseille, France
| | - Michel Weber
- 26922University Hospital Centre Nantes, Nantes, Pays de la Loire, France
| |
Collapse
|
3
|
Morel C, Conrath J, Morin B, Parrat E, Zito E, Desoudain C, Pernot A, Chauvet G, Hajjar C, Lemaitre S, Billiard P, Blanquat PS, Uzel JL, Bezeaud D, Villeroy F, N'Guyen P, Devin F, Matonti F. The AflibeRcept use in rEal life study for the treatment of diabetiC macular oedema In the French overseas territories: A 12 months follow-up Study - The RECIF Study. Eur J Ophthalmol 2021; 32:11206721211055020. [PMID: 34747231 DOI: 10.1177/11206721211055020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The incidence and severity of diabetes is particularly high in the French overseas territories (FOT). The RECIF study evaluated real life management of diabetic macular oedema (DME) treated by aflibercept in FOT. METHODS A prospective, noncomparative, multicentric, non-interventional, study that evaluated functional and anatomical results of patients treated by aflibercept. Twelve retina specialists working in French Polynesia, La Reunion, Guadeloupe and Martinique participated in the study. RESULTS 67 eyes of 57 patients were followed for 12 months. Average VA gain was 7.8 ETDRS letters. 29.9% of eyes gained at least 15 letters, 6% lost 15 letters or more. 67.2% of eyes achieved visual acuity of 70 letters or better. Average central retinal thickness decrease was 115.3 µm. The mean number of injections during the 1st year of treatment was 4.9. 69% of eyes had a loading dose of at least three-monthly injections. 3 eyes were switched to steroid injections during the follow-up for lack of efficacy. CONCLUSION This study confirmed the efficacy of intravitreal treatment of DME by aflibercept, in the French overseas territories. This evaluation of real-life management of DME underlines the importance of improvement of patient education and collaboration with referring physicians.
Collapse
Affiliation(s)
- Christophe Morel
- Centre Monticelli Paradis, Marseille, France
- AOM3 Association, Centre Paradis Monticelli, Marseille, France
- Groupe Almaviva Santé, Clinique Juge, Marseille, France
| | - John Conrath
- Centre Monticelli Paradis, Marseille, France
- AOM3 Association, Centre Paradis Monticelli, Marseille, France
- Groupe Almaviva Santé, Clinique Juge, Marseille, France
| | - Bruno Morin
- Centre Monticelli Paradis, Marseille, France
- AOM3 Association, Centre Paradis Monticelli, Marseille, France
- Groupe Almaviva Santé, Clinique Juge, Marseille, France
| | - Eric Parrat
- Centre ophtalmologique de Baie Mahault, Guadeloupe, France
| | - Eleonora Zito
- Clinique Cardella, Papette, Tahiti, Polynésie Française
| | | | - Anne Pernot
- Groupe Medical Colir - Le Port, La Réunion, France
| | - Guy Chauvet
- Centre ophtalmologique de Saint Pierre, La Réunion, France
| | | | | | | | | | | | - Dominique Bezeaud
- Centre ophtalmologique de Tamanu, Punaauia, Tahiti, Polynésie Française
| | | | - Patrick N'Guyen
- Centre hospitalier régional de Saint Denis, La Réunion, France
| | - François Devin
- Centre Monticelli Paradis, Marseille, France
- AOM3 Association, Centre Paradis Monticelli, Marseille, France
- Groupe Almaviva Santé, Clinique Juge, Marseille, France
| | - Frederic Matonti
- Centre Monticelli Paradis, Marseille, France
- AOM3 Association, Centre Paradis Monticelli, Marseille, France
- Groupe Almaviva Santé, Clinique Juge, Marseille, France
- 128791Aix Marseille Univ, CNRS, INT, Inst Neurosci Timone, Marseille, France
| |
Collapse
|