Diabetic macular edema: a literature review

Diabetic Macular Edema is a major cause of visual impairment in economically active population, being responsible for a significant impact in quality of life in the affected population, as well as high costs to the health care system. Over decades, some studies have compared treatments using Laser, Anti-VEGF and intravitreous corticosteroids, establishing protocols to reach effectives therapies. Thus, it is essential an entire understanding of available therapies to reach the goal of disease control, in an individual basis and in a collective health care system, as efficient as possible.

Intravitreal anti-VEGF monotherapy for thick submacular hemorrhage of less than 1 week duration secondary to neovascular age-related macular degeneration.

Aim: To investigate the role of anti‑VEGF monotherapy in patients with thick submacular hemorrhage (SMH) of ≤1 week duration secondary to neovascular age‑related macular degeneration (N‑AMD). Materials and Methods: A retrospective chart review of 14 eyes of 14 patients presenting with acute decrease in central vision of ≤1 week duration secondary to a thick SMH measuring ≥ 2 MPS disk areas from N‑AMD was performed. Intravitreal injections of bevacizumab 1.25 mg (13 eyes) or ranibizumab 0.5 mg (1 eye) were given monthly until resolution of SMH and less frequently thereafter, based on treat-and-extend approach utilizing spectral domain optical coherence tomography (SDOCT). Patients with follow‑up of ≥6 months were included. Results: Patients presented after a median of 4 (range 1-7) days from the onset of SMH. Mean lesion size was 27.9 mm2 (range 5.47-100, median 15), with blood comprising 77-98% of the lesion. Presenting visual acuity (VA) ranged from 20/60 to hand motions (median 20/200). Patients received a mean of 11.4 (range 5-20) injections over 18.4 (range 7-50) months. SMH resolved in all eyes in a mean of 4.8 (range 2-8) months. At 6 months follow‑up, mean VA gain was −0.54 logMAR (range: −1.5 to +1, Snellen range 20/25‑20/400, median 20/100, P = 0.0037), with 11 gaining ≥0.2 logMAR. Mean change in VA from baseline at final follow‑up was −0.58 logMAR (range −1.6 to +1, Snellen range 20/30-20/400, median 20/60; P = 0.0022). Conclusion: A good anatomical and visual outcome can be accomplished in patients with thick SMH secondary to N‑AMD treated with anti‑VEGF monotherapy within 1 week.