Clinical Ophthalmology (Sep 2022)

Expert Panel Consensus for Addressing Anti-VEGF Treatment Challenges of Diabetic Macular Edema in Spain

  • Fernández-Vigo JI,
  • Contreras I,
  • Crespo MJ,
  • Beckford C,
  • Flores-Moreno I,
  • Cobo-Soriano R,
  • Pareja J,
  • Martín MD,
  • Moreno L,
  • Arrevola-Velasco L

Journal volume & issue
Vol. Volume 16
pp. 3097 – 3106

Abstract

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José Ignacio Fernández-Vigo,1 Inés Contreras,2 María José Crespo,3 Carlos Beckford,4 Ignacio Flores-Moreno,5 Rosario Cobo-Soriano,6 Jesús Pareja,7 María Dolores Martín,8 Luis Moreno,9 Luis Arrevola-Velasco10 1Deparment of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain; 2Deparment of Ophthalmology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) and Clínica Rementería, Madrid, Spain; 3Department of Ophthalmology, Hospital Universitario Infanta Leonor, Madrid, Spain; 4Department of Ophthalmology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain; 5Department of Ophthalmology, Hospital Universitario Puerta de Hierro, Madrid, Spain; 6Department of Ophthalmology, Hospital Universitario Henares, Universidad Francisco de Vitoria, Madrid, Spain; 7Department of Ophthalmology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; 8Department of Ophthalmology, Hospital Infanta Cristina, Madrid, Spain; 9Department of Ophthalmology, Hospital 12 de Octubre, Madrid, Spain; 10Department of Ophthalmology, Clinica Baviera Instituto Oftalmológico Europeo, Madrid, SpainCorrespondence: Luis Arrevola-Velasco, Department of Ophthalmology, Clínica Baviera Instituto Oftalmológico Europeo, P.° de la Castellana, 20, Madrid, 28046, Spain, Tel +34 917 82 03 60, Email [email protected]: The treatment of diabetic macular edema (DME) has evolved rapidly in the past decade, highlighting the need to address the challenges of routine clinical practice decision-making through expert consensus agreements.Methods: After a literature review and discussion of real-world experience on DME management, a group of ten retina specialists agreed on a consensus of recommendations for the most appropriate management of DME patients using vascular endothelial growth factor inhibitors (anti-VEGF) in Spain.Results: The panel recommended early treatment initiation in DME patients with worse baseline visual acuity (VA) to maintain or improve outcome. For patients with good VA, an observation strategy was recommended, considering the presence of diabetic retinopathy, optical coherence tomography biomarkers, and impact on patient’s quality of life. Based on the available evidence and clinical experience, the panel recommended the use of anti-VEGF intensive loading doses with the objective of achieving anatomic and visual responses as soon as possible, followed by a Treat & Extend (T&E) strategy to maintain VA improvement. Aflibercept was recommended for patients with a baseline decimal VA < 0.5, followed by a T&E strategy, including the possibility to extend frequency of injections up to 16 weeks.Conclusion: An expert panel proposes a consensus for the management of DME in Spain. Early treatment initiation with anti-VEGF in DME patients is recommended to maintain or improve VA; aflibercept is recommended for patients with a poor baseline VA.Keywords: diabetic macular edema, clinical practice patterns, intravitreal injections, consensus

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