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The causes of macular edema are numerous and different causes may be inter-related. It is commonly associated with diabetes.Chronic or uncontrolled diabetes type 2 can affect peripheral blood vessels including those of the retina which may leak fluid, blood and occasionally fats into the retina causing it to swell.
Diabetic retinopathy (also known as diabetic eye disease) is a medical condition in which damage occurs to the retina due to diabetes.It is a leading cause of blindness in developed countries and one of the lead causes of sight loss in the world, even though there are many new therapies and improved treatments for helping people live with diabetes.
There are also increasing off-label use of bevacizumab (Avastin) for the management of various ophthalmologic diseases, like AMD, retinal vein occlusion and diabetic macular edema. [2] [9] On top of that, the number of intravitreal injections has escalated from less than 3000 per year in 1999, to an estimation of near 6 million in 2016. [2] [7]
The number of injections tripled to 15,000 in 2002 when triamcinolone injections were first used to treat diabetic macular oedema. [2] [3] This use continued to drive an increase to 83,000 injections in 2004. [2] In 2005 bevacizumab and ranibizumab intravitreal injections for the treatment of wet-AMD caused a rise in injections to 252,000. [2]
Ranibizumab, sold under the brand name Lucentis among others, is a monoclonal antibody fragment created from the same parent mouse antibody as bevacizumab.It is an anti-angiogenic [16] that is approved to treat the "wet" type of age-related macular degeneration (AMD, also ARMD), diabetic retinopathy, and macular edema due to branch retinal vein occlusion or central retinal vein occlusion.
The American Academy of Ophthalmology practice guidelines recommend laser coagulation for people who have both mild to moderate nonproliferative diabetic retinopathy (NPDR) and clinically significant macular edema outside the fovea; treatment with anti-VEGF drugs is better than laser coagulation for clinically significant macular edema in the fovea. [1]
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