Clinical Ophthalmology (Jul 2021)
Challenges in Diabetic Macular Edema Management: An Expert Consensus Report
Abstract
Patricia Udaondo,1 Alfredo Adan,2 Luis Arias-Barquet,3 Francisco J Ascaso,4 Francisco Cabrera-López,5 Verónica Castro-Navarro,6 Juan Donate-López,7 Alfredo García-Layana,8 Francisco Javier Lavid,9 Mariano Rodríguez-Maqueda,10 José María Ruiz-Moreno11 1Department of Ophthalmology, Hospital Universitario y Politecnico la FE, Valencia, Spain; 2Department of Ophthalmology, Hospital Clinic Barcelona, Barcelona, Spain; 3Department of Ophthalmology, University Complex Bellvitge, Barcelona, Spain; 4Department of Ophthalmology, Hospital Universitario Lozano Blesa, Zaragoza, Spain; 5Department of Ophthalmology, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain; 6Department of Ophthalmology, Hospital General Universitario, Valencia, Spain; 7Department of Ophthalmology, Hospital Clínico San Carlos, Madrid, Spain; 8Department of Ophthalmology, Clínica Universitaria de Navarra, Pamplona, Spain; 9Department of Ophthalmology, Hospital Punta Europa, Algeciras, Cádiz, Spain; 10Department of Ophthalmology, Hospital Virgen del Rocío, Sevilla, Spain; 11Department of Ophthalmology, Hospital Puerta de Hierro, Majadahonda, Madrid, SpainCorrespondence: Patricia UdaondoAiken Prevención y Cirugía ocular, Pizarro, 15 Bajo, Valencia, 46004, SpainTel +34647869228Email [email protected]: This paper aimed to present daily-practice recommendations for the management of diabetic macular edema (DME) patients based on available scientific evidence and the clinical experience of the consensus panel.Methods: A group of Spanish retina experts agreed to discuss different aspects related with the clinical management of DME patients.Results: Panel was mainly focused on therapeutic objectives in DME management; definition terms; and role of biomarkers as prognostic and predictive factors to intravitreal treatment response. The panel recommends to start DME treatment as soon as possible in those eyes with a visual acuity less than 20/25 (always according to the retina unit capacity). Naïve patient was defined, in a strict manner, as a patient who, up to that moment, had never received any treatment. A refractory DME patient may be defined as the one who did not achieve a complete resolution of the disease, regardless of the treatment administered. Different optical coherence tomography biomarkers, such as disorganization of the retinal inner layers, hyperreflective dots, and cysts, have been identified as prognostic factors.Conclusion: This document has sought to lay down a set of recommendations and to identify key issues that may be useful for the daily management of DME patients.Keywords: diabetes, diabetic macular edema, optical coherence tomography, inflammation, biomarkers, consensus
