Actualización en el tratamiento del edema macular diabético

Abstract

Diabetic macular edema (DME) is a common cause of vision loss due to microvascular damage that results in exaggerated production by the ischemic retina of endothelial growth factor (VEGF) and other inflammatory factors such as cytokines, which alter vascular permeability and deturgecent function of the retinal pigment epithelium (PE)(1, 2). There are three forms of DME, those that do not affect the central region, those that affect the central region with preserved visual acuity (VA) and those with severely compromised VA (Protocol 19). Intravitreal antiangiogenic therapy is the first-line choice when the central VA is affected. Aflibercept has been shown to be more effective in patients with DME and VA equal to or worse than 20/40. Laser photocoagulation is reserved for cases where local leakage is demonstrated outside the 500 microns of the foveolar avascular zone (19,20). Intravitreal depot corticosteroids are used as rescue therapy alone or in combination with an anti-VEGF. Lately,
eslerale implants (PDS) are being used, which are recharged with antiangiogenics (ranibizumad).