This article is more than 5 years old. Information may no longer be current.
Combined treatment might improve results in diabetic macular edema
 Francesco Bandello |
LONDON — Diabetic macular edema might be more effectively treated with a combined approach, taking into account the complex multifactorial pathogenesis and multiple manifestations of the disease, according to a specialist at the Euretina meeting here.
By reviewing the results of clinical trials, Francesco Bandello, MD, summarized some of the conclusions achieved thus far.
"Combined anti-VEGF and laser treatment has shown efficacy in both the READ-2 and RESTORE studies. The two treatments act synergistically, increasing and prolonging their beneficial effect," he said.
The best approach seems to be an initial aggressive treatment with Lucentis (ranibizumab, Genentech) followed by an as-needed regimen along with focal/grid laser.
The combination of laser and intravitreal steroids produced conflicting results. Steroids enhance visual outcomes, but the high rates of cataract formation and IOP increase are a concern.
"The new sustained-release steroid implants will hopefully prove safer and provide a beneficial long-term effect in combination with laser," Dr. Bandello said.
Triple therapy involving sequentially combined vitrectomy, intravitreal steroids and grid laser has only been evaluated in a small, non-comparative case series, but it has a strong rationale and deserves further investigation, he said.
- Disclosure: Dr. Bandello is an advisory board member for Novartis, Allergan, Pfizer, Bayer and Thea.