[Diabetic maculopathy].

Area of Science:

• Ophthalmology
• Diabetology
• Retinal Diseases

Background:

• Diabetic maculopathy involves complex retinal capillary changes in diabetes mellitus.
• It presents as ischemic maculopathy or diabetic macular edema (DME).
• DME is a primary cause of vision loss in working-age individuals.

Purpose of the Study:

• To review the efficacy of current treatments for diabetic macular edema.
• To compare intravitreal pharmacotherapy with laser coagulation and steroids.
• To discuss surgical interventions for specific cases.

Main Methods:

• Review of large randomized clinical trials on intravitreal pharmacotherapy.
• Analysis of outcomes for vascular endothelial growth factor (VEGF) inhibitors (ranibizumab, aflibercept).
• Comparison with focal/grid laser coagulation, steroid implants (dexamethasone, fluocinolone), and vitrectomy.

Main Results:

• Intravitreal VEGF inhibitors demonstrate excellent functional and morphological outcomes for fovea-involving DME.
• VEGF inhibitors outperform focal or grid laser coagulation alone.
• Steroids are alternatives, with fluocinolone as a second-line option for refractory cases.
• Focal laser is the standard for non-fovea-involving edema; panretinal laser prevents neovascularization.

Conclusions:

• Intravitreal VEGF inhibitors are highly effective for treating diabetic macular edema involving the fovea.
• Laser photocoagulation remains crucial for specific indications like non-fovea-involving edema and neovascularization prevention.
• Surgical options like vitrectomy are reserved for cases with significant vitreoretinal traction.