Therapeutic Options in Refractory Diabetic Macular Oedema
Diabetic macular oedema (DMO) results from alterations of several biochemical pathways in diabetic eyes. Centre-involving DMO is an important cause of visual loss in diabetes. Anti-vascular endothelial growth factor agents are now the mainstay of centre-involving DMO treatment. Oedema that does not...
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| Veröffentlicht in: | Drugs (New York, N.Y.) N.Y.), 2017-04, Vol.77 (5), p.481-492 |
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| description | Diabetic macular oedema (DMO) results from alterations of several biochemical pathways in diabetic eyes. Centre-involving DMO is an important cause of visual loss in diabetes. Anti-vascular endothelial growth factor agents are now the mainstay of centre-involving DMO treatment. Oedema that does not achieve optimal response to these agents occurs in a sizeable proportion of eyes and is called refractory or persistent DMO. Management of refractory DMO is challenging. In this paper, the pathophysiology of DMO, and the definitions used in various studies are summarised. Therapeutic options for refractory DMO management including corticosteroids, laser, combination therapies, and surgery are explored. Novel agents on the horizon for DMO control that are being investigated at present are discussed as well. A literature review was performed and a summary of the research studies for each of the agents is provided in order to guide the reader regarding the existing evidence for their application in DMO. Importance of early recognition of disease and prompt treatment to achieve best visual outcome is discussed. Utility of optical coherence tomography to guide disease diagnosis and monitoring is highlighted. An algorithmic approach for DMO management is described. Finally, the impact that personalized medicine and genetics might have on DMO management is assessed. |
| doi_str_mv | 10.1007/s40265-017-0704-6 |
| format | Article |
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Centre-involving DMO is an important cause of visual loss in diabetes. Anti-vascular endothelial growth factor agents are now the mainstay of centre-involving DMO treatment. Oedema that does not achieve optimal response to these agents occurs in a sizeable proportion of eyes and is called refractory or persistent DMO. Management of refractory DMO is challenging. In this paper, the pathophysiology of DMO, and the definitions used in various studies are summarised. Therapeutic options for refractory DMO management including corticosteroids, laser, combination therapies, and surgery are explored. Novel agents on the horizon for DMO control that are being investigated at present are discussed as well. A literature review was performed and a summary of the research studies for each of the agents is provided in order to guide the reader regarding the existing evidence for their application in DMO. Importance of early recognition of disease and prompt treatment to achieve best visual outcome is discussed. Utility of optical coherence tomography to guide disease diagnosis and monitoring is highlighted. An algorithmic approach for DMO management is described. Finally, the impact that personalized medicine and genetics might have on DMO management is assessed.</description><identifier>ISSN: 0012-6667</identifier><identifier>EISSN: 1179-1950</identifier><identifier>DOI: 10.1007/s40265-017-0704-6</identifier><identifier>PMID: 28197794</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Angiogenesis Inhibitors - administration & dosage ; Angiogenesis Inhibitors - therapeutic use ; Combined Modality Therapy ; Corticoids ; Corticosteroids ; Current Opinion ; Cytokines ; Diabetes ; Diabetes mellitus ; Diabetic retinopathy ; Diabetic Retinopathy - complications ; Diabetic Retinopathy - drug therapy ; Diabetic Retinopathy - physiopathology ; Disease control ; Edema ; Endothelium ; Eye (anatomy) ; Genetics ; Humans ; Hyperglycemia ; Internal Medicine ; Kinases ; Lasers ; Literature reviews ; Macular Edema - complications ; Macular Edema - drug therapy ; Macular Edema - physiopathology ; Management ; Medicine ; Medicine & Public Health ; Metabolism ; Optical Coherence Tomography ; Oxidative stress ; Pathogenesis ; Pathophysiology ; Pharmacology/Toxicology ; Pharmacotherapy ; Precision medicine ; Proteins ; Retina ; Studies ; Surgery ; Tomography ; Vascular endothelial growth factor ; Visual perception</subject><ispartof>Drugs (New York, N.Y.), 2017-04, Vol.77 (5), p.481-492</ispartof><rights>Springer International Publishing Switzerland 2017</rights><rights>Copyright Springer Science & Business Media Apr 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-22056739d1306f5ef5e34bbd1c9ec91ffc4543a7e4629a66c0b9fcd93576e9863</citedby><cites>FETCH-LOGICAL-c372t-22056739d1306f5ef5e34bbd1c9ec91ffc4543a7e4629a66c0b9fcd93576e9863</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40265-017-0704-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40265-017-0704-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28197794$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shah, Sanket U.</creatorcontrib><creatorcontrib>Maturi, Raj K.</creatorcontrib><title>Therapeutic Options in Refractory Diabetic Macular Oedema</title><title>Drugs (New York, N.Y.)</title><addtitle>Drugs</addtitle><addtitle>Drugs</addtitle><description>Diabetic macular oedema (DMO) results from alterations of several biochemical pathways in diabetic eyes. Centre-involving DMO is an important cause of visual loss in diabetes. Anti-vascular endothelial growth factor agents are now the mainstay of centre-involving DMO treatment. Oedema that does not achieve optimal response to these agents occurs in a sizeable proportion of eyes and is called refractory or persistent DMO. Management of refractory DMO is challenging. In this paper, the pathophysiology of DMO, and the definitions used in various studies are summarised. Therapeutic options for refractory DMO management including corticosteroids, laser, combination therapies, and surgery are explored. Novel agents on the horizon for DMO control that are being investigated at present are discussed as well. A literature review was performed and a summary of the research studies for each of the agents is provided in order to guide the reader regarding the existing evidence for their application in DMO. Importance of early recognition of disease and prompt treatment to achieve best visual outcome is discussed. Utility of optical coherence tomography to guide disease diagnosis and monitoring is highlighted. An algorithmic approach for DMO management is described. Finally, the impact that personalized medicine and genetics might have on DMO management is assessed.</description><subject>Angiogenesis Inhibitors - administration & dosage</subject><subject>Angiogenesis Inhibitors - therapeutic use</subject><subject>Combined Modality Therapy</subject><subject>Corticoids</subject><subject>Corticosteroids</subject><subject>Current Opinion</subject><subject>Cytokines</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetic retinopathy</subject><subject>Diabetic Retinopathy - complications</subject><subject>Diabetic Retinopathy - drug therapy</subject><subject>Diabetic Retinopathy - physiopathology</subject><subject>Disease control</subject><subject>Edema</subject><subject>Endothelium</subject><subject>Eye (anatomy)</subject><subject>Genetics</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Internal Medicine</subject><subject>Kinases</subject><subject>Lasers</subject><subject>Literature reviews</subject><subject>Macular Edema - complications</subject><subject>Macular Edema - drug therapy</subject><subject>Macular Edema - physiopathology</subject><subject>Management</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolism</subject><subject>Optical Coherence Tomography</subject><subject>Oxidative stress</subject><subject>Pathogenesis</subject><subject>Pathophysiology</subject><subject>Pharmacology/Toxicology</subject><subject>Pharmacotherapy</subject><subject>Precision medicine</subject><subject>Proteins</subject><subject>Retina</subject><subject>Studies</subject><subject>Surgery</subject><subject>Tomography</subject><subject>Vascular endothelial growth factor</subject><subject>Visual perception</subject><issn>0012-6667</issn><issn>1179-1950</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kN9LwzAQx4Mobk7_AF-k4Isv1VyaJr1HmT9hMpD5HNL0qh1bO5P2Yf-9LZsighA4wn3ue8eHsXPg18C5vgmSC5XGHHTMNZexOmBjAI0xYMoP2ZhzELFSSo_YSQjL4YspHrORyAC1RjlmuPggbzfUtZWL5pu2auoQVXX0SqW3rm38NrqrbE5D-8W6bmV9NKeC1vaUHZV2FehsXyfs7eF-MX2KZ_PH5-ntLHaJFm0sBE-VTrCAhKsypf4lMs8LcEgOoSydTGViNUkl0CrleI6lKzBJtSLMVDJhV7vcjW8-OwqtWVfB0Wpla2q6YCBTmUKFIHv08g-6bDpf99cZQCEVZEkGPQU7yvkmBE-l2fhqbf3WADeDV7PzanqvZvBqhiMu9sldvqbiZ-JbZA-IHRD6Vv1O_tfqf1O_APxJgN8</recordid><startdate>20170401</startdate><enddate>20170401</enddate><creator>Shah, Sanket U.</creator><creator>Maturi, Raj K.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7QO</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20170401</creationdate><title>Therapeutic Options in Refractory Diabetic Macular Oedema</title><author>Shah, Sanket U. ; Maturi, Raj K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-22056739d1306f5ef5e34bbd1c9ec91ffc4543a7e4629a66c0b9fcd93576e9863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Angiogenesis Inhibitors - administration & dosage</topic><topic>Angiogenesis Inhibitors - therapeutic use</topic><topic>Combined Modality Therapy</topic><topic>Corticoids</topic><topic>Corticosteroids</topic><topic>Current Opinion</topic><topic>Cytokines</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetic retinopathy</topic><topic>Diabetic Retinopathy - complications</topic><topic>Diabetic Retinopathy - drug therapy</topic><topic>Diabetic Retinopathy - physiopathology</topic><topic>Disease control</topic><topic>Edema</topic><topic>Endothelium</topic><topic>Eye (anatomy)</topic><topic>Genetics</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>Internal Medicine</topic><topic>Kinases</topic><topic>Lasers</topic><topic>Literature reviews</topic><topic>Macular Edema - complications</topic><topic>Macular Edema - drug therapy</topic><topic>Macular Edema - physiopathology</topic><topic>Management</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolism</topic><topic>Optical Coherence Tomography</topic><topic>Oxidative stress</topic><topic>Pathogenesis</topic><topic>Pathophysiology</topic><topic>Pharmacology/Toxicology</topic><topic>Pharmacotherapy</topic><topic>Precision medicine</topic><topic>Proteins</topic><topic>Retina</topic><topic>Studies</topic><topic>Surgery</topic><topic>Tomography</topic><topic>Vascular endothelial growth factor</topic><topic>Visual perception</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shah, Sanket U.</creatorcontrib><creatorcontrib>Maturi, Raj K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Drugs (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shah, Sanket U.</au><au>Maturi, Raj K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Therapeutic Options in Refractory Diabetic Macular Oedema</atitle><jtitle>Drugs (New York, N.Y.)</jtitle><stitle>Drugs</stitle><addtitle>Drugs</addtitle><date>2017-04-01</date><risdate>2017</risdate><volume>77</volume><issue>5</issue><spage>481</spage><epage>492</epage><pages>481-492</pages><issn>0012-6667</issn><eissn>1179-1950</eissn><abstract>Diabetic macular oedema (DMO) results from alterations of several biochemical pathways in diabetic eyes. Centre-involving DMO is an important cause of visual loss in diabetes. Anti-vascular endothelial growth factor agents are now the mainstay of centre-involving DMO treatment. Oedema that does not achieve optimal response to these agents occurs in a sizeable proportion of eyes and is called refractory or persistent DMO. Management of refractory DMO is challenging. In this paper, the pathophysiology of DMO, and the definitions used in various studies are summarised. Therapeutic options for refractory DMO management including corticosteroids, laser, combination therapies, and surgery are explored. Novel agents on the horizon for DMO control that are being investigated at present are discussed as well. A literature review was performed and a summary of the research studies for each of the agents is provided in order to guide the reader regarding the existing evidence for their application in DMO. Importance of early recognition of disease and prompt treatment to achieve best visual outcome is discussed. Utility of optical coherence tomography to guide disease diagnosis and monitoring is highlighted. An algorithmic approach for DMO management is described. Finally, the impact that personalized medicine and genetics might have on DMO management is assessed.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>28197794</pmid><doi>10.1007/s40265-017-0704-6</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Angiogenesis Inhibitors - administration & dosage Angiogenesis Inhibitors - therapeutic use Combined Modality Therapy Corticoids Corticosteroids Current Opinion Cytokines Diabetes Diabetes mellitus Diabetic retinopathy Diabetic Retinopathy - complications Diabetic Retinopathy - drug therapy Diabetic Retinopathy - physiopathology Disease control Edema Endothelium Eye (anatomy) Genetics Humans Hyperglycemia Internal Medicine Kinases Lasers Literature reviews Macular Edema - complications Macular Edema - drug therapy Macular Edema - physiopathology Management Medicine Medicine & Public Health Metabolism Optical Coherence Tomography Oxidative stress Pathogenesis Pathophysiology Pharmacology/Toxicology Pharmacotherapy Precision medicine Proteins Retina Studies Surgery Tomography Vascular endothelial growth factor Visual perception |
| title | Therapeutic Options in Refractory Diabetic Macular Oedema |
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