TY - JOUR
T1 - Diabetic retinopathy, diabetic macular edema, and cardiovascular risk: the importance of a long-term perspective and a multidisciplinary approach to optimal intravitreal therapy
T2 - Acta Diabetologica
AU - Bandello, F.
AU - Toni, D.
AU - Porta, M.
AU - Varano, M.
N1 - Cited By :5
Export Date: 11 March 2021
CODEN: ACDAE
Correspondence Address: Bandello, F.; Department of Ophthalmology, Via Olgettina Milano, 58, Italy; email: bandello.francesco@hsr.it
Chemicals/CAS: aflibercept, 845771-78-0, 862111-32-8; bevacizumab, 216974-75-3, 1438851-35-4; dexamethasone, 50-02-2; ranibizumab, 347396-82-1; vasculotropin, 127464-60-2; Angiogenesis Inhibitors; Dexamethasone; Glucocorticoids
Funding details: Allergan
Funding text 1: We thank Ray Hill, an independent medical writer, who provided English language editing and journal styling prior to submission on behalf of Health Publishing & Services Srl and funded by Allergan SpA, Italy. All authors met the ICMJE authorship criteria. Neither honoraria nor payments were made for authorship.
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
KW - Anti-VEGF (vascular endothelial growth factor) agents
KW - Cardiovascular (CV) risk
KW - Corticosteroids
KW - Diabetic macular edema (DME)
KW - Diabetic retinopathy (DR)
KW - aflibercept
KW - bevacizumab
KW - corticosteroid
KW - dexamethasone
KW - ranibizumab
KW - vasculotropin
KW - vasculotropin antibody
KW - angiogenesis inhibitor
KW - glucocorticoid
KW - cardiovascular disease
KW - cardiovascular mortality
KW - cardiovascular risk
KW - comorbidity
KW - diabetic macular edema
KW - diabetic patient
KW - diabetic retinopathy
KW - disease association
KW - drug efficacy
KW - drug use
KW - holistic care
KW - human
KW - insulin dependent diabetes mellitus
KW - multidisciplinary team
KW - non insulin dependent diabetes mellitus
KW - nonhuman
KW - patient care
KW - priority journal
KW - Review
KW - risk management
KW - risk reduction
KW - treatment response
KW - vitreoretinal surgery
KW - diabetic complication
KW - macular edema
KW - multimodality cancer therapy
KW - randomized controlled trial (topic)
KW - Angiogenesis Inhibitors
KW - Cardiovascular Diseases
KW - Combined Modality Therapy
KW - Dexamethasone
KW - Diabetes Complications
KW - Diabetic Retinopathy
KW - Glucocorticoids
KW - Humans
KW - Macular Edema
KW - Randomized Controlled Trials as Topic
U2 - 10.1007/s00592-019-01453-z
DO - 10.1007/s00592-019-01453-z
M3 - Article
VL - 57
SP - 513
EP - 526
JO - Acta Diabetol.
JF - Acta Diabetol.
SN - 0940-5429
IS - 5
ER -