Diabetic macular edema treatment

In recent years intraocular delivery of medication, including anti-vascular endothelial growth fector, corticosteroids and related compounds, and antiviral agents, has either been approved or is under study for treatment of macular degeneration, uveitis, cytomegalovirus, or diabetic macular edema (Table 2-5).This area of research and development is growing rapidly. 

Posterior snb-Tenon s injection of corticosteroids is most often nsed in the treatment of chronic eqnatorial and mid-zone posterior uveitis, including inflammation of the macnlar region. Cystoid macular edema after cataract extraction and diabetic macular edema are treated occasionally with snb-Tenon s repository steroids. 

Intravitreal triamcinolone has been used to treat diffuse diabetic macular edema. Also, an intravitreal implant delivering fluocinolone acetonide (Retisert) is effective in the treatment of patients with noninfectious posterior uveitis who have failed to respond to conventional treatment. 

Thus, there exist a variety of predominantly acute edematous retinal disorders that may be amenable for treatment with an intravitreous injection of INS37217. For treatment of chronic conditions such as cystoid or diabetic macular edema, alternative means of intravitreous delivery, such as intravitreous insert or implant or a sustained-release formulation, will likely be required. 

Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number... 

Jonas JB, Degenring RF, Kamppeter BA, et al. Duration of the effect of intravitreal triamcinolone acetonide as treatment for diffuse diabetic macular edema. Am J Ophthalmol 2004 138(1) 158—160. 

Jonas JB, Sofker A. Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema. Am J Ophthalmol 2001 132 425 -27. 

Intravitreously administered steroids have been used for decades for treating intraocular inflammation and retinal edema. However, during the recent years, increased attention has also been focused on the potential of this treatment to reduce diabetic macular edema. The effect is assumed to be due to... 

In addition to cancer treatments as described previously, inhibition of PKCp may also ameliorate vascular dysfunctions due to diabetes. To this end, a series of macrocychc bisindolylmaleimide compounds has been synthesized as exemplified by Ruboxistaurin [24] (http //www.lilly.com/pdf/Pipeline Slide.pdf). This agent is under regulatory review for the potential oral treatment of diabetic retinopathy (DR) and diabetic macular edema. 

PDT is now established as part of the ophthalmologist s armamentarium for the treatment of abnormal vascular conditions in the eye. The therapy is proven to be safe and efficacious. In addition to the diseases mentioned above, there are a number of other ocular conditions in which PDT could play a role. These include diabetic macular edema, diabetic retinopathy, corneal neovasculature, and ocular tumors. While there are alternative therapies for these conditions, unlike AMD where there was no treatment, it is possible that PDT may offer some advantages over existing therapies. 

Colucciello M. Vision loss due to macular edema induced by rosiglitazone treatment of diabetes mellitus. Arch Ophthalmol 2005 123 1273-5. 

Intravitreal triamcinolone acetonide use has increased recently following case series of successful treatment of edema due to various etiologies as well as choroidal neovascularization. It has been advocated for the treatment of macular edema associated with diabetes (54), uveitis (38,39), and central retinal vein occlusion (55). In addition, it has been proposed as adjunctive treatment for proliferative diabetic retinopathy (41) and exudative AMD (43,44). 

Recently, macular edema associated with uveitis (29), diabetic retinopathy (30), and central retinal vein occlusion (31,32) has been treated with intravitreal injection of triamcinolone acetonide. Macular edema decreased after treatment but recurred three to six months after injection. A sustained-release steroid delivery system may be more attractive than a simple injection of triamcinolone as it could reduce or eliminate the need for multiple intravitreal injections. 

Bevacizumab has been studied in advanced carcinoid tumors [167 ], prostate cancer [168 ], high-risk corneal transplantation [169 ], diabetic retinopathy [170 , 171, 172 ], ischemic retinal diseases [173 ], refractory choroidal neovascularization secondary to uveitis [174 ], macular edema secondary to branch retinal vein occlusion [175 ], retinal angiomatous proliferation [176% choroidal neovascularization attributable to pathological myopia [177, 178], exudative age-related macular degeneration [179 ], multifocal lymphangioendothe-liomatosis with thrombocytopenia [180" ], in combination with chemotherapy for the treatment of recurrent ovarian cancer [181 j, advanced melanoma [182 ], malignant pleural mesothelioma [183 ],... 

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