[Treatment switch in diabetic macular edema: Literature review and management algorithm]. / Les switchs de traitement dans l'Ådème maculaire diabétique : revue de la littérature et algorithme de prise en charge.
J Fr Ophtalmol
; 43(8): 710-717, 2020 Oct.
Article
in Fr
| MEDLINE
| ID: mdl-32653096
ABSTRACT
Initial management of diabetic macular edema (DME) is well-defined, but there is a lack of national or international consensus for patients who do not respond or respond only partially to these treatments. Several studies, mostly retrospective, have assessed medication switches, but currently, the literature contains no randomized studies. The goal of this article is to present an algorithm for switching medications, which can be proposed to DME patients treated with anti-VEGF agents, as defined by a group of French retina experts, supported by the existing literature on the subject. After initiation of an anti-VEGF treatment for DME, the response is usually assessed after 5 monthly injections. A partial anatomical response (reduction of central retinal thickness between 10 and 20%), seen in 30 to 40% of patients, is associated with a favorable visual prognosis according to randomized studies. Continuation of the anti-VEGF injections after the induction phase is thus possible. If the response remains incomplete after 3 additional anti-VEGF injections, a complete ophthalmologic examination should be performed, and a switch to another therapeutic class (corticosteroids) may be proposed in the absence of contraindications. If a complete non-response is seen initially (reduction of central retinal thickness<10%), the switch is proposed immediately after the induction phase.
Key words
Anatomic non-response; Anti-VEGF; Corticosteroids; Corticoïdes; Diabetic macular edema; Injections intravitréennes; Intravitreal injections; Medication switch; Non-réponse anatomique; Non-réponse fonctionnelle; Partial response; Réponse partielle; Switch thérapeutique; Visual acuity non-response; Ådème maculaire diabétique
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Algorithms
/
Macular Edema
/
Practice Guidelines as Topic
/
Diabetic Retinopathy
/
Drug Substitution
Type of study:
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Limits:
Humans
Language:
Fr
Journal:
J Fr Ophtalmol
Year:
2020
Document type:
Article