Anti-VEGF the mainstay in DME management
As a second-line agent, steroids may be used in combination anti-VEGF
Although anti-vascular endothelial growth factor (anti-VEGF) drugs remain first-line agents in the management of diabetic macular oedema (DME), corticosteroids may still play a role in patients where anti-VEGF is contraindicated, unavailable or unaffordable, according to Sobha Sivaprasad MD.
“We know that the visual outcome will not be as good as anti-VEGF when using steroids. As a second-line agent, steroids may potentially be used in combination with an anti-VEGF agent. Although it has been recommended in pseudophakics who are non-responsive to anti-VEGF, the recent evidence from the Protocol U study suggests that very few patients will actually benefit,” she said.
In DME cases where there is no visual impairment, the best strategy is observation, said Dr Sivaprasad. She advised that any of the approved anti-VEGF agents should be administered on a tight treatment schedule in cases of DME with mild visual impairment. For patients whose visual acuity of 20/50 or worse, aflibercept should be the agent of choice as it performs better in more severe cases, she said.
For proliferative diabetic retinopathy (PDR), panretinal photocoagulation remains the standard of care in 2019.
“Anti-VEGF treatments may offer significant advantages but we need a good surveillance programme to be able to provide urgent anti-VEGF therapy if there is recurrence or reactivation of new vessels as non-perfusion continues to increase. The complications are disastrous if not treated properly in these cases,” she concluded.