Therapies for DME and Rationale for Combination Therapy
Therapies for DME and Rationale for Combination Therapy
This review has evaluated the individual treatments available for DMO, and discussed the rationale and potential for combination therapy in DMO. Systemic factors including blood sugar, blood pressure, and lipids cannot be over-emphasised.
The ideal treatment for DMO should improve vision and morphological changes in the macular (eg, reduce macular oedema) for a significant duration, reduce adverse events, reduce treatment burden and costs, and be well tolerated by patients. Laser photocoagulation is of limited use in centre-involving DMO, and requires augmentation in eyes where the foveal centre is threatened. No current individual treatment modality in DMO results in a completely dry macula in most cases. This is understandable as there are multiple mechanisms including VEGF pathway, and the non-VEGF inflammation, which becomes more important in the chronic stages of DMO. Eyes with chronic DMO are more likely to befit from intravitreal steroid therapy. A combination of anti-VEGF therapies with steroids will provide more optimal pharmacotherapy, and may be supplemented with macular laser photocoagulation as necessary in individual cases. Newer agents in the future will further enhance efficacy of our treatments for DMO.
Conclusion
This review has evaluated the individual treatments available for DMO, and discussed the rationale and potential for combination therapy in DMO. Systemic factors including blood sugar, blood pressure, and lipids cannot be over-emphasised.
The ideal treatment for DMO should improve vision and morphological changes in the macular (eg, reduce macular oedema) for a significant duration, reduce adverse events, reduce treatment burden and costs, and be well tolerated by patients. Laser photocoagulation is of limited use in centre-involving DMO, and requires augmentation in eyes where the foveal centre is threatened. No current individual treatment modality in DMO results in a completely dry macula in most cases. This is understandable as there are multiple mechanisms including VEGF pathway, and the non-VEGF inflammation, which becomes more important in the chronic stages of DMO. Eyes with chronic DMO are more likely to befit from intravitreal steroid therapy. A combination of anti-VEGF therapies with steroids will provide more optimal pharmacotherapy, and may be supplemented with macular laser photocoagulation as necessary in individual cases. Newer agents in the future will further enhance efficacy of our treatments for DMO.
