[Treatment switch in diabetic macular edema: Literature review and management algorithm]

Area of Science:

• Ophthalmology
• Retinal Diseases
• Medical Treatments

Background:

• Diabetic macular edema (DME) initial management lacks consensus for non-responders.
• Existing studies on medication switches are mostly retrospective, lacking randomized trials.
• Anti-VEGF agents are standard initial therapy for DME.

Purpose of the Study:

• To propose an expert-defined algorithm for switching anti-VEGF therapy in DME patients.
• To provide guidance for managing DME patients with incomplete or no response to initial treatment.
• To support clinical decision-making with existing literature.

Main Methods:

• Development of a treatment algorithm by French retina experts.
• Review of existing literature on anti-VEGF therapy and medication switching in DME.
• Assessment of treatment response based on central retinal thickness reduction.

Main Results:

• A partial anatomical response (10-20% CRT reduction) allows continuation of anti-VEGF therapy.
• If response remains incomplete after 3 additional injections, consider switching to corticosteroids.
• An immediate switch to corticosteroids is proposed for initial complete non-response (<10% CRT reduction).

Conclusions:

• The proposed algorithm offers a structured approach to managing DME patients refractory to anti-VEGF therapy.
• Switching to corticosteroids is a viable option for non-responders, contingent on contraindications.
• Further randomized studies are needed to validate treatment-switching strategies in DME.