Diabetic retinopathy, diabetic macular edema, and cardiovascular risk: the importance of a long-term perspective and a multidisciplinary approach to optimal intravitreal therapy: Acta Diabetologica

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Abstract

Diabetic retinopathy (DR), diabetic macular edema (DME), and cardiovascular disease (CVD) resulting from vascular damage from persistently elevated blood glucose levels are among the serious secondary pathologies associated with long-standing diabetes mellitus. The established link between DR and CVD suggests the need for appropriate and early management of patients with diabetes to minimize CV risk. This is of particular importance in patients with recent, or a history of, major CV events. Early management of DR is a complex task that requires comprehensive evaluation and a multidisciplinary approach to manage complications, risk factors, and interactions between different aspects of the disease. Anti-vascular endothelial growth factor (VEGF) agents have become an important therapeutic modality in ophthalmology. However, their use is contraindicated in patients with DR and/or DME with a CV event in the previous 3 months. In patients with DME, corticosteroids target the multifaceted inflammatory pathways involved in the pathogenesis of DR, with a broader spectrum of action than anti-VEGF agents. In this context, recent guidelines suggest the use of corticosteroids, and in particular dexamethasone intravitreal implant, as a well-tolerated and efficacious first-line treatment in patients with high CV risk, such as a history of or recent major CV events. This review focuses on the subset of diabetic patients with a prior CV event, DR, and DME and discusses the need for a holistic approach in evaluating the optimal therapeutic choice for the care of the individual patient, supported by real-world clinical experience on long-term dexamethasone intravitreal implant therapy. © 2019, Springer-Verlag Italia S.r.l., part of Springer Nature.
Original languageEnglish
Pages (from-to)513-526
Number of pages14
JournalActa Diabetol.
Volume57
Issue number5
DOIs
Publication statusPublished - 2020

Keywords

  • Anti-VEGF (vascular endothelial growth factor) agents
  • Cardiovascular (CV) risk
  • Corticosteroids
  • Diabetic macular edema (DME)
  • Diabetic retinopathy (DR)
  • aflibercept
  • bevacizumab
  • corticosteroid
  • dexamethasone
  • ranibizumab
  • vasculotropin
  • vasculotropin antibody
  • angiogenesis inhibitor
  • glucocorticoid
  • cardiovascular disease
  • cardiovascular mortality
  • cardiovascular risk
  • comorbidity
  • diabetic macular edema
  • diabetic patient
  • diabetic retinopathy
  • disease association
  • drug efficacy
  • drug use
  • holistic care
  • human
  • insulin dependent diabetes mellitus
  • multidisciplinary team
  • non insulin dependent diabetes mellitus
  • nonhuman
  • patient care
  • priority journal
  • Review
  • risk management
  • risk reduction
  • treatment response
  • vitreoretinal surgery
  • diabetic complication
  • macular edema
  • multimodality cancer therapy
  • randomized controlled trial (topic)
  • Angiogenesis Inhibitors
  • Cardiovascular Diseases
  • Combined Modality Therapy
  • Dexamethasone
  • Diabetes Complications
  • Diabetic Retinopathy
  • Glucocorticoids
  • Humans
  • Macular Edema
  • Randomized Controlled Trials as Topic

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