摘要
Diabetic macular edema(DME) is the leading cause of blindness among working aged individuals of industrialized countries. The Early Treatment of Diabetic Retinopathy Studies(ETDRS) demonstrated that timely laser photocoagulation significantly decreases vision loss from DME, thereby establishing laser as standard- of-care for over 2 decades. Unfortunately, only a minority of patients treated in the ETDRS experienced significant improvements in visual acuity(VA), leaving researchers to look for more effective interventions. The recently introduced drugs(ranibizumab, aflibercept) that prevent the binding of vascular endothelial growth factor(VEGF) to its trans-membrane receptors produce superior improvements in VA over laser, either when administered as monotherapy or when combined with as-needed supplemental macular laser photocoagulation. The pivotal phase Ⅲ trials featured monthly(ranibizumab, aflibercept) or bimonthly(aflibercept) injections of each drug for 2 years during which a significant number of patients experienced improved diabetic retinopathy(DR) severity scores. The need for anti-VEGF injections dropped significantly after 1-3 years in both the RISE/RIDE and DRCR.net Protocol Ⅰ trials indicating that VEGF production had diminished. These data led to the FDA approval of both ranibizumab and aflibercept for the treatment of DR complicated by DME. Physicians may now treat vision-threatening DME with ranibizumab or aflibercept while simultaneously improving DR and possibly achieving long-term regression.
Diabetic macular edema （DME） is the leading cause of blindness among working aged individuals of industrialized countries. The Early Treatment of Diabetic Retinopathy Studies （ETDRS） demonstrated that timely laser photocoagulation signifcantly decreases vision loss from DME, thereby establishing laser as standard- of-care for over 2 decades. Unfortunately, only a minority of patients treated in the ETDRS experienced signifcant improvements in visual acuity （VA）, leaving researchers to look for more effective interventions. The recently introduced drugs （ranibizumab, afibercept） that prevent the binding of vascular endothelial growth factor （VEGF） to its trans-membrane receptors produce superior improvements in VA over laser, either when administ-ered as monotherapy or when combined with as-needed supplemental macular laser photocoagulation. The pivotal phase Ⅲ trials featured monthly （ranibizumab, afibercept） or bimonthly （afibercept） injections of each drug for 2 years during which a significant number of patients experienced improved diabetic retinopathy （DR） severity scores. The need for anti-VEGF injections dropped significantly after 1-3 years in both the RISE/RIDE and DRCR.net Protocol Ⅰ trials indicating that VEGF production had diminished. These data led to the FDA approval of both ranibizumab and aflibercept for the treatment of DR complicated by DME. Physicians may now treat vision-threatening DME with ranibizumab or aflibercept while simultaneously improving DR and possibly achieving long-term regression.
