According to the guideline, patients with visual impairment due to central DME can start with the vascular endothelial growth factor (VEGF) inhibitor bevacizumab. In case of low vision (0.4 or less), aflibercept intravitreal can be considered. If no effect is achieved after treatment with three to six injections, the patient can be switched to another VEGF inhibitor, such as ranibizumab, or an intravitreal corticosteroid. The disadvantage of treatment with corticosteroids is the increased risk of eye side effects, such as increased intraocular pressure and cataract progression.
VEGF inhibitors have been given an important place in the revised guideline. This is due to the new insights that have been gained in recent years, especially in the field of treatment with intravitreal injections. The studies show that repeated injections of VEGF inhibitors have a clear added value compared to treatment with laser alone.
VEGF inhibitors can improve vision and slow down vision loss by counteracting the action of VEGF. VEGF induces inflammation, vascular permeability and angiogenesis. These processes probably play a role in the visual impairment caused by DME.
Macular edema is an accumulation of fluid in the central part of the retina, the macula. This reduces visibility. Diabetic macular edema can result from diabetic retinopathy.
The guideline Diabetic retinopathy of the Dutch Internists Association has been drawn up in collaboration with ophthalmologists, general practitioners and optometrists.