糖尿病性黄斑水肿(DME)的治疗方法通常具有挑战性。本综述的目的是就接触DME患者时使用玻璃体内地塞米松植入物(DEX)提出循证建议。对来自欧洲和亚洲的不同视网膜专家小组编辑的七个国家共识进行了审查和面对。每个共识都使用Delphi方法编辑,在个人会议中,或通过查阅文献。DEX可以作为一线策略在患有炎症性OCT生物标志物的DME患者中进行研究,在玻璃体切除的眼睛中,在最近发生心血管事件的患者中,在孕妇身上,计划接受白内障手术或依从性差的患者。考虑的其他参数是DME治疗的适应症,何时切换到DEX,抗VEGFs药物和DEX植入物无应答者的定义,是否将DEX与激光光凝相结合,青光眼和DEX之间的联系,以及DEX和白内障的管理。尽管在DME治疗中引入DEX植入物已经过去了几年,视网膜专家之间仍然没有统一的协议。本文比较了来自不同大洲的国家之间的DME治疗方法,并提供了该主题的更广泛和全球范围的观点。
Diabetic macular edema (
DME)\'s therapeutic approach can frequently be challenging. The purpose of the review is to propose evidence-based recommendations on the employment of intravitreal dexamethasone implants (DEX) when approaching patients suffering from
DME. Seven national consensuses redacted by different groups of retina specialists from Europe and Asia were examined and confronted. Each
consensus was redacted utilizing a Delphi approach, in person meetings, or by reviewing the literature. DEX can be studied as a first-line strategy in individuals suffering from DME with inflammatory OCT biomarkers, in vitrectomized eyes, in patients with recent cardiovascular events, in pregnant women, in patients scheduled to undergo cataract surgery or with poor compliance. The other parameters considered were the indications to the
DME treatment, when to switch to DEX, the definition of non-responder to anti-VEGFs agents and to the DEX implant, whether to combine DEX with laser photocoagulation, the association between glaucoma and DEX, and the management of DEX and the cataract. Although several years have passed since the introduction of DEX implants in the
DME treatment, there is still not a unified agreement among retina specialists. This paper compares the approach in the DME treatment between countries from different continents and provides a broader and worldwide perspective of the topic.