Challenges in Diabetic Macular Edema Management: An Expert Consensus Report

Abstract

Purpose

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

Acknowledgments

Medical writing and editorial assistance services have been provided by Antonio Martínez (MD) of Ciencia y Deporte S.L. and covered by a Grant from Allergan. Support for this assistance was funded by Allergan, an AbbVie company.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, agreed to the submitted journal, and agreed to be accountable for all aspects of the work.

Disclosure

Dr Patricia Udaondo reports grants from Allergan, an AbbVie company, during the conduct of the study. Dr Veronica Castro-Navarro reports grants from Allergan, an AbbVie company, over the last year. Dr José María Ruiz Moreno reports grants from Allergan, an AbbVie company, over the last year. Dr Javier Ascaso reports personal fees from Allergan, personal fees from Novartis, personal fees from Bayer, personal fees from Brill Pharma, personal fees from Alcon, outside the submitted work. Dr Alfredo García-Layana reports personal fees from Allergan, personal fees from Novartis, personal fees from Bayer, personal fees from Roche, grants, personal fees from Thea, during the conduct of the study. Dr Francisco Javier Lavid reports personal fees from Allergan, during the conduct of the study; personal fees from Novartis, personal fees from Bayer, personal fees from Allergan, outside the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

Logistic for writing services has been provided by Allergan, an AbbVie company. Allergan did not participate in either data analysis or redaction of the manuscript.