diabetic retinopathy and maculopathy management

- EXECUTIVE SUMMARY

In PDR and severe NPDR

Severe non proliferative DR

·  compliant patient without diabetic maculopathy: regular follow up

Recommendation: conditional

·    non-compliant patient without diabetic maculopathy: laser PRP

Recommendation: Strong

 PDR and high risk PDR without diabetic maculopathy and no abundant fibrosis

·   Non-compliant patient: laser PRP

Recommendation: strong

·  Compliant patient: Laser PRP or antiVEGF injection within 4 weeks;

Recommendation: strong

PDR and high risk PDR with diabetic maculopathy

·  Compliant patient: antiVEGF before PRP

Recommendation: moderate

Non compliant patient: laser PRP with focal/grid laser for the macula

Recommendation: moderate

NCI-DME:

·  Vision 6/12 or better in compliant patients: observe with control of risk factors.

 Recommendation: strong

·  Vision 6/12 or better in non-compliant patients: laser treatment based on angiography and OCT

Recommendation:  strong

· Vision less than 6/12: no treatment and investigate to exclude ischemic maculopathy, if present, IVI of anti VEGF or steroids

Recommendation: consensous

CI-DME

·   Vision better than 6/12 compliant patient: observe with control of risk factors

Recommendation: Conditional

·   Vision better than 6/12 non compliant patient: laser treatment

Recommendation: strong

·  Vision less than 6/12 in compliant patient: AntiVEGF

Recommendation: strong

·  Vision less than 6/12 in non compliant patient: laser

Recommendation: strong

·  Vision less than 6/12 with signs of vitreo-retinal traction: Vitrectomy +/-AntiVEGF

Recommendation: strong

·  Refractory DME: received a minimum of three monthly injections of AntiVEGF with poor anatomical and functional response in compliant patient: intra vitreal steroids/vitrectomy

only in places with subspecialty retinal service.

Recommendation: strong

Introduction:

Diabetes mellitus (DM) is an alarming public health issue globally and its prevalence is increasing heavily in developing countries [1-4]. The number of diabetics between 20 and 79 years of age is estimated to be 415 million people in the world and is expected to rise to 642 million in 2040.[5] In Egypt, DM is a dilemma and a fast-expanding concern. According to the International Diabetes Federation (IDF), the prevalence of DM among Egyptian adults is 15.2%, which may be an underestimation [6]. Diabetic retinopathy (DR) is one of the major complications of diabetes and leading cause of visual impairment or blindness. One of the most devastating complications of diabetes is diabetic retinopathy, which can be potentially blinding [7-14]. Evidence through the years reveals that almost all type I and around 60% of type II diabetic patients develop some degree of retinopathy within 20 years after diagnosis [15]. Given the increasing number of diabetics worldwide, developing countries are expected to receive the greatest toll [14].