Current Management of Diabetic Macular Edema

Ogugua Ndubuisi Okonkwo, T. Akanbi, Chineze Thelma Agweye
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Abstract

Diabetic macular edema is a complication of diabetes mellitus (DM) which contributes significantly to the burden of visual impairment amongst persons living with diabetes. Chronic hyperglycemia triggers a cascade of pathologic changes resulting in breakdown of the retinal blood barrier. Understanding the pathophysiological and biochemical changes occurring in diabetes has led to developing novel therapeutics and effective management strategies for treating DME. The clinical utility of optical coherence tomography (OCT) imaging of the retina provides a detailed assessment of the retina microstructure, valid for individualization of patient treatment and monitoring response to treatment. Similarly, OCT angiography (dye-less angiography), another innovation in imaging of DME, provides an understanding of retinal vasculature in DME. From the earlier years of using retinal laser photocoagulation as the gold standard for treating DME, to the current use of intravitreal injection of drugs, several clinical trials provided evidence on safety and efficacy for the shift to intravitreal steroids and anti-vascular endothelial growth factor use. The short durability of available drugs leading to frequent intravitreal injections and frequent clinic visits for monitoring constitute an enormous burden. Therefore, extended durability drugs are being designed, and remote monitoring of DME may be a solution to the current challenges.
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糖尿病性黄斑水肿的当前处理
糖尿病性黄斑水肿是糖尿病(DM)的一种并发症,对糖尿病患者的视力损害有重要影响。慢性高血糖会引发一连串的病理变化,导致视网膜血液屏障的破坏。了解糖尿病中发生的病理生理和生化变化导致开发新的治疗方法和有效的管理策略来治疗二甲醚。视网膜光学相干断层扫描(OCT)成像的临床应用提供了视网膜微观结构的详细评估,有效的个体化患者治疗和监测对治疗的反应。同样,OCT血管造影(无染料血管造影)是DME成像的另一项创新,它提供了对DME视网膜血管系统的了解。从早期使用视网膜激光光凝作为治疗二甲醚的金标准,到目前使用玻璃体内注射药物,一些临床试验为玻璃体内类固醇和抗血管内皮生长因子的使用提供了安全性和有效性的证据。现有药物的持久性短,导致频繁的玻璃体内注射和频繁的门诊监测,构成了巨大的负担。因此,人们正在设计延长持久性的药物,而对二甲醚的远程监测可能是解决当前挑战的一种方法。
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