Management of Diabetic Retinopathy
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1 Management of Diabetic Retinopathy
2 Developments in Ophthalmology Vol. 60 Series Editor F. Bandello Milan
3 Management of Diabetic Retinopathy Volume Editors Francesco Bandello Milan Marco A. Zarbin Newark, NJ Rosangela Lattanzio Milan Ilaria Zucchiatti Milan 77 figures, 64 in color, and 30 tables, 2017 Basel Freiburg Paris London New York Chennai New Delhi Bangkok Beijing Shanghai Tokyo Kuala Lumpur Singapore Sydney
4 Francesco Bandello Rosangela Lattanzio Marco A. Zarbin Institute of Ophthalmology and Visual Science New Jersey Medical School Rutgers University 6th Floor Doctors Office Center 90 Bergen Street Newark, NJ (USA) Ilaria Zucchiatti Library of Congress Cataloging-in-Publication Data Names: Bandello, F. (Francesco), editor. Zarbin, Marco A., editor. Lattanzio, R. (Rosangela), editor. Zucchiatti, Ilaria, editor. Title: Management of diabetic retinopathy / volume editors, Francesco Bandello, Marco A. Zarbin, Rosangela Lattanzio, Ilaria Zucchiatti. Other titles: Management of diabetic retinopathy (Bandello) Developments in ophthalmology ; v Description: Basel ; New York : Karger, Series: Developments in ophthalmology, ISSN ; vol. 60 Includes bibliographical references and index. Identifiers: LCCN ISBN (hard cover : alk. paper) ISBN (e-isbn) Subjects: MESH: Diabetic Retinopathy--therapy Macular Edema Diabetic Retinopathy--diagnostic imaging Classification: LCC RE661.D5 NLM WK 835 DDC 617.7/3--dc23 LC record available at Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents and Index Medicus. Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2017 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) Printed on acid-free and non-aging paper (ISO 9706) ISSN e-issn ISBN e-isbn
5 Contents VII List of Contributors X Preface Bandello, F. (Milan); Zarbin, M.A. (Newark, NJ); Lattanzio, R.; Zucchiatti, I. (Milan) Epidemiology 1 The Burden of Diabetes: Emerging Data Maffi, P.; Secchi, A. (Milan) 6 The Eye as a Window to the Microvascular Complications of Diabetes Zerbini, G.; Maestroni, S.; Turco, V.; Secchi, A. (Milan) Pathogenesis and Imaging 16 Emerging Insights into Pathogenesis Midena, E. (Padova/Rome); Pilotto, E. (Padova) 28 Emerging Issues for Optical Coherence Tomography Pierro, L.; Rabiolo, A. (Milan) 38 Optical Coherence Tomography Angiography in Diabetic Maculopathy Coscas, G. (Paris); Lupidi, M. (Paris/Perugia); Coscas, F. (Paris) 50 Emerging Issues for Ultra-Wide Field Angiography Rabiolo, A.; De Vitis, L.A. (Milan); Sacconi, R. (Milan/Verona); Carnevali, A. (Milan/Catanzaro); Querques, L.; Bandello, F.; Querques, G. (Milan) 56 Emerging Simplified Retinal Imaging Sharma, A. (Coimbatore) Treatment 63 Intravitreal Ranibizumab in Diabetic Macular Edema: Long-Term Outcomes Zucchiatti, I.; Bandello, F. (Milan) 71 Intravitreal Aflibercept in Diabetic Macular Edema: Long-Term Outcomes Introini, U.; Casalino, G. (Milan) 78 Intravitreal Steroids in Diabetic Macular Edema Lattanzio, R.; Cicinelli, M.V.; Bandello, F. (Milan) V
6 91 Practical Lessons from Protocol I for the Management of Diabetic Macular Edema Mukkamala, L.; Bhagat, N.; Zarbin, M.A. (Newark, NJ) 109 Practical Lessons from Protocol T for the Management of Diabetic Macular Edema Mukkamala, L.; Bhagat, N.; Zarbin, M.A. (Newark, NJ) 125 Is Laser Still Important in Diabetic Macular Edema as Primary or Deferral Therapy? Battaglia Parodi, M.; Bandello, F. (Milan) 131 Anti-Vascular Endothelial Growth Factor Injections: The New Standard of Care in Proliferative Diabetic Retinopathy? Li, X.; Zarbin, M.A.; Bhagat, N. (Newark, NJ) 143 Surgical Management and Techniques Codenotti, M.; Iuliano, L.; Maestranzi, G. (Milan) 160 Enzymatic Vitreolysis for Vitreomacular Traction in Diabetic Retinopathy Rizzo, S.; Bacherini, D. (Florence) 165 Diabetic Macular Edema: Emerging Strategies and Treatment Algorithms Moisseiev, E.; Loewenstein, A. (Tel Aviv) 175 Application of Clinical Trial Results to Clinical Practice Zarbin, M.A.; Bhagat, N.; Mukkamala, L.K. (Newark, NJ) 190 Subject Index VI Contents
7 List of Contributors Daniela Bacherini Department of Surgery and Translational Medicine Careggi University Hospital, Eye Clinic University of Florence Largo Piero Palagi, 1 IT Florence (Italy) daniela.bacherini@gmail.com Francesco Bandello bandello.francesco@hsr.it Maurizio Battaglia Parodi battagliaparodi.maurizio@hsr.it Neelakshi Bhagat Institute of Ophthalmology and Visual Science New Jersey Medical School Rutgers University 6th Floor Doctors Office Center 90 Bergen Street Newark, NJ (USA) bhagatne@njms.rutgers.edu Adriano Carnevali University of Magna Graecia Viale Europa, Germaneto, IT Catanzaro (Italy) adrianocarnevali@live.it Giuseppe Casalino peppecasalino@gmail.com Maria Vittoria Cicinelli cicinelli.mariavittoria@hsr.it Marco Codenotti codenotti.marco@hsr.it Florence Coscas Hôpital de Créteil Département d Ophtalmologie de Créteil Université Paris XII, Val de Marne-France Centre d Exploration Ophtalmologique de l Odéon FR Paris (France) coscas.f@gmail.com Gabriel Coscas Hôpital de Créteil Département d Ophtalmologie de Créteil Université Paris XII, Val de Marne-France Centre d Exploration Ophtalmologique de l Odéon F Paris (France) gabriel.coscas@gmail.com VII
8 Luigi Antonio De Vitis IRCCS Ospedale San Raffaele Ugo Introini Lorenzo Iuliano Rosangela Lattanzio Xintong Li Institute of Ophthalmology and Visual Science New Jersey Medical School Rutgers University 6th Floor Doctors Office Center 90 Bergen Street Newark, NJ (USA) Anat Loewenstein Tel Aviv Medical Center Weitzman 6 St. Tel Aviv, (Israel) anatl@tlvmc.gov.il Marco Lupidi Department of Biomedical and Surgical Sciences Section of Ophthalmology S. Maria della Misericordia Hospital University of Perugia IT Perugia (Italy) dr.marco.lupidi@gmail.com Gisella Maestranzi maestranzi.gisella@hsr.it Silvia Maestroni Complications of Diabetes Unit Diabetes Research Institute IRCCS maestroni.silvia@hsr.it Paola Maffi Internal Medicine and Transplant Unit IRCCS paola.maffi@hsr.it Edouardo Midena University of Padova Via Giustiniani, 2 IT Padova (Italy) edoardo.midena@unipd.it Elad Moisseiev Tel Aviv Medical Center Weitzman 6 St. Tel Aviv, (Israel) elad_moi@netvision.net.il Lekha Mukkamala Institute of Ophthalmology and Visual Science New Jersey Medical School Rutgers University 6th Floor Doctors Office Center 90 Bergen Street Newark, NJ (USA) lravindraraj99@gmail.com Luisa Pierro pierro.luisa@hsr.it VIII List of Contributors
9 Elisabetta Pilotto University of Padova Via Giustiniani, 2 IT Padova (Italy) elisabetta.pilotto@unipd.it Giuseppe Querques IRCCS Ospedale San Raffaele querques.giuseppe@hsr.it Alessandro Rabiolo Department of Opthalmology IRCCS Ospedale San Raffaele rabiolo.alessandro@hsr.it Stanislao Rizzo Department of Surgery and Translational Medicine Careggi University Hospital, Eye Clinic University of Florence Largo Piero Palagi, 1 IT Florence (Italy) stanislao.rizzo@gmail.com Riccardo Sacconi ric.sacconi@gmail.com Ashish Sharma Lotus Eye Hospital and Institute Coimbatore, TN, (India) drashish79@hotmail.com Valentina Turco Complications of Diabetes Unit Diabetes Research Institute IRCCS turco.vnt@gmail.com Marco A. Zarbin Institute of Ophthalmology and Visual Science New Jersey Medical School Rutgers University 6th Floor Doctors Office Center 90 Bergen Street Newark, NJ (USA) zarbin@earthlink.net Gianpaolo Zerbini Complications of Diabetes Unit Diabetes Research Institute IRCCS zerbini.gianpaolo@hsr.it Ilaria Zucchiatti ilaria.zucchiatti@gmail.com Antonio Secchi Internal Medicine, Vita-Salute San Raffaele University IRCCS secchi.antonio@hsr.it List of Contributors IX
10 Preface Diabetic retinopathy is the leading cause of blindness among working-age individuals in the industrialized world. Our understanding of the pathogenesis of this condition continues to evolve as does the treatment of its sight-threatening complications: diabetic macular edema and proliferative diabetic retinopathy. This book provides the latest information on the pathogenesis and diagnosis of diabetic retinopathy. In addition, the results of all relevant randomized clinical trials that serve as the basis for modern treatment of diabetic retinopathy are reviewed. The impact of modern diagnostic (e.g., optical coherence tomography-angiography) and therapeutic (e.g., smallgauge vitrectomy) technology is reviewed. Most importantly, this book does not simply provide a convenient summary of this critical information. Because data from randomized trials usually cannot be directly translated into clinical practice (e.g., due to limitations of patient enrollment or other aspects of study design), the data are analyzed and interpreted by highly experienced clinicians with the goal of facilitating application of these results to routine clinical practice. Ophthalmology residents, fellows, and practicing clinicians will find this book to be a useful reference when seeking evidence-based treatment strategies for various complications of diabetic retinopathy. Members of the pharmaceutical industry will find this overview useful when attempting to identify new avenues for drug development and unmet therapeutic needs in the management of diabetic retinopathy at all stages of the disease. Members of the insurance industry and overseers of national health policy will find this book to be a useful reference when trying to establish evidence-based guidelines for therapeutic intervention in managing the complications of diabetic retinopathy. Francesco Bandello, Milan Marco A. Zarbin, Newark, NJ Rosangela Lattanzio, Milan Ilaria Zucchiatti, Milan X
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