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Review of clinical studies and recommendation for a therapeutic flow chart for diabetic macular edema

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Abstract

Diabetic macular edema (DME), characterized by exudative fluid accumulation in the macula, is the most common form of sight-threatening retinopathy in patients with diabetes. The management of DME has changed considerably in recent years, especially following the development of intravitreal anti-vascular endothelial growth factor therapy which has emerged as a first-line therapy for center-involved DME. Laser treatment, intravitreal steroid therapy, and vitrectomy are also important treatment options for DME. We believe that it is important to choose the most appropriate treatment option for DME based on the clinical evidences, in addition to the careful consideration of individual patients’ general or ocular condition, DME characteristics, patients’ motivation, and compliance to the treatment in real-world clinical practice. In this review, we have summarized important clinical evidences for the main treatments for DME, presented an expert review for these evidences, and proposed a recommended therapeutic flow chart for DME. We hope that our review of the clinical evidences and the recommended therapeutic flow chart for DME will contribute to better treatment outcome for DME.

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Authors and Affiliations

  1. Department of Ophthalmology, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka, 830-0011, Japan

    Shigeo Yoshida

  2. Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan

    Tomoaki Murakami

  3. Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya-Shi, Aichi, 467-8601, Japan

    Miho Nozaki

  4. Department of Ophthalmology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kagawa, Kita-gun, 761-0793, Japan

    Kiyoshi Suzuma

  5. Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan

    Takayuki Baba

  6. Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, Nagano, 390-8621, Japan

    Takao Hirano

  7. Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu-shi, Shiga, 520-2192, Japan

    Osamu Sawada

  8. Department of Ophthalmology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu-shi, Mie, 514-8507, Japan

    Masahiko Sugimoto

  9. Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, 23-3, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan

    Yoshihiro Takamura

  10. Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki-shi, Nagasaki, 852-8523, Japan

    Eiko Tsuiki

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  1. Shigeo Yoshida
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Correspondence to Shigeo Yoshida.

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Conflict of interest

Shigeo Yoshida has received a speaker honorarium from Bayer Yakuhin, Ltd., Novartis Pharma K.K., and Santen Pharmaceutical Co., Ltd. and has received subsidy and donation from Bayer Yakuhin, Ltd., and Santen Pharmaceutical Co. Tomoaki Murakami has received a speaker honorarium from Bayer Yakuhin, Ltd., and Novartis Pharma K.K. and has received research funds from Novartis Pharma K.K. Miho Nozaki has received a speaker honorarium from Novartis Pharma K.K. Takao Hirano has received a speaker honorarium from Novartis Pharma K.K. Masahiko Sugimoto has received a research funds from Alcon Japan Ltd., and Bayer Yakuhin, Ltd. and has received speaker honorarium and consulting fees from Alcon Japan Ltd., Kowa Company, Ltd., Senju Pharmaceutical Co., Ltd., Daiichi Yakuhin Sangyo Co., Ltd., Bayer Yakuhin, Ltd., and Wakamoto Pharmaceutical Co., Ltd.

Interscience Co., Ltd. assisted in the writing and editing of this paper with funding from Bayer Yakuhin, Ltd. All authors wrote this review considering the view of expert doctors with the assistance of Interscience Co., Ltd.; however, Bayer Yakuhin, Ltd. has not been involved in the preparation of this article in any way.

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Yoshida, S., Murakami, T., Nozaki, M. et al. Review of clinical studies and recommendation for a therapeutic flow chart for diabetic macular edema. Graefes Arch Clin Exp Ophthalmol 259, 815–836 (2021). https://doi.org/10.1007/s00417-020-04936-w

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