Looking Back on an Innovative Year in Ophthalmology

Ronald C. Gentile, MD; Tal Raviv, MD; Joseph F. Panarelli, MD; Richard B. Rosen, MD


December 29, 2014

In This Article

New Diabetic Macular Edema Treatments

This year witnessed an explosion of treatment options for diabetic macular edema (DME). The FDA approved three new intravitreal pharmaceuticals for the treatment of DME.

Aflibercept (approved July 2014)[5] is an anti-vascular endothelial growth factor (VEGF) molecule made up of a soluble VEGF receptor fusion protein that binds to all forms of VEGF-A and related placental growth factor. The dexamethasone implant (approved June 2014)[6] contains 0.7 mg of dexamethasone in the form of a sustained-release biodegradable steroid implant that can last from 1 to 3 months. It is injected using a single-use applicator via a 22-gauge needle with a shelved injection technique. Fluocinolone acetonide implant (approved September 2014)[7] contains 0.19 mg of fluocinolone acetonide in an injectable, nonerodible, corticosteroid implant designed to release submicrogram levels of drug for 36 months. It is injected using an applicator via a 25-gauge needle.

These three drugs were added to the existing armamentarium alongside the intravitreal pharmaceuticals ranibizumab (approved August 2012)[8] and bevacizumab, the latter of which has been used off-label for almost a decade.[9]

In addition to these five intravitreal pharmaceuticals, laser treatments for DME remain an important tool for stabilization. Just as intravitreal pharmaceuticals have proliferated, so too have the types of lasers and techniques used for administering them in DME.

Lasers have had a significant evolution in this area, and barely resemble the focal laser treatment strategies performed during the landmark Early Treatment Diabetic Retinopathy Study (ETDRS) study of the 1980s.[10] Although standard laser treatments for DME have been shown in certain studies to have less favorable outcomes than pure intravitreal pharmacotherapy strategies, they still have significant practical value.

Newer techniques and advances in laser technology are still being developed and have become more popular in an attempt to decrease intravitreal treatment burdens. Subvisible threshold laser treatments to the retina and retinal pigment epithelium using various minimal dosing strategies, such as micropulsing, "endpoint management," or computer-assisted navigated laser, appear to reduce the photothermal damaging effect while maintaining efficacy.[11]


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