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Diabetic macular edema might be more effectively treated with
a combined approach, taking into account the complex multifactorial
pathogenesis and multiple manifestations of the disease, according to a
specialist at the
Euretina meeting here.
By reviewing the results of clinical trials, Francesco Bandello, MD,
summarized some of the conclusions achieved thus far.
"Combined anti-VEGF and laser treatment has shown efficacy in both the
READ-2 and RESTORE studies. The two treatments act
synergistically, increasing and prolonging their beneficial effect," he said.
The best approach seems to be an initial aggressive treatment with
Genentech) followed by an as-needed regimen along with
The combination of laser and intravitreal steroids produced conflicting
results. Steroids enhance visual outcomes, but the high rates of cataract
formation and IOP increase are a concern.
"The new sustained-release steroid implants will hopefully prove safer
and provide a beneficial long-term effect in combination with laser," Dr.
Triple therapy involving sequentially combined vitrectomy, intravitreal
steroids and grid laser has only been evaluated in a small, non-comparative
case series, but it has a strong rationale and deserves further investigation,
- Disclosure: Dr. Bandello is an advisory board member for Novartis,
Allergan, Pfizer, Bayer and Thea.