Ogura Yuichiro, Shiraga Fumio, Terasaki Hiroko, Ohji Masahito, Ishida Susumu, Sakamoto Taiji, Hirakata Akito, Ishibashi Tatsuro
Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Jpn J Ophthalmol. 2017 Jan;61(1):43-50. doi: 10.1007/s10384-016-0481-x. Epub 2016 Oct 8.
To elucidate the current clinical practice patterns of diabetic macular edema (DME) management by retinal specialists in Japan in the era of anti-vascular endothelial growth factor (VEGF) therapy.
Forty-six retinal specialists were administered a survey regarding the pathology and clinical practice of DME.
Nearly, half of the specialists (45.2 %) think that the main biochemical factor involved in DME development is the vascular permeability-potentiating action of VEGF-A. Most specialists (70.6 %) use three modalities for detecting DME: optical coherence tomography, fluorescein angiography, and fundus examination. For focal macular edema, focal laser is used as first-line therapy by 70.3 % of specialists, whereas 21.6 % use medical treatment in combination with focal/grid laser. For diffuse macular edema, anti-VEGF therapy is the first choice (72.5 %), irrespective of visual acuity, whereas 17.5 % select off-label sub-Tenon's steroid injections. Vitrectomy is often performed for vitreomacular traction (86.5 %) or when anti-VEGF agent/laser therapy is ineffective (73.2 %). For persistent DME after vitrectomy, anti-VEGF agents (46.3 %) or steroids (intravitreal injections, 14.6 %; sub-Tenon's injections, 36.6 %) are selected. When applying anti-VEGF treatment regimen, most specialists continue loading injections until central retinal thickness stabilized (51.4 %) or both visual acuity and central retinal thickness stabilized (24.3 %). In the maintenance phase, many specialists provide injections with pro re nata (76.3 %), whereas 50.0 % responded that the treat-and-extend regimen is ideal.
Our survey presents the current views about the DME management and practice patterns of anti-VEGF therapy by one part of the retinal specialists in Japan, and highlights the differences or gaps between evidence and actual clinical practice.
阐明在抗血管内皮生长因子（VEGF）治疗时代，日本视网膜专科医生对糖尿病性黄斑水肿（DME）的当前临床治疗模式。
对46位视网膜专科医生进行了关于DME病理学和临床实践的调查。
近一半的专科医生（45.2%）认为参与DME发生发展的主要生化因素是VEGF-A增强血管通透性的作用。大多数专科医生（70.6%）使用三种方法检测DME：光学相干断层扫描、荧光素血管造影和眼底检查。对于局灶性黄斑水肿，70.3%的专科医生将局部激光治疗作为一线治疗方法，而21.6%的医生采用药物治疗联合局部/格栅样激光治疗。对于弥漫性黄斑水肿，无论视力如何，抗VEGF治疗都是首选（72.5%），而17.5%的医生选择非标签的球后类固醇注射。玻璃体切除术常用于治疗玻璃体黄斑牵引（86.5%）或抗VEGF药物/激光治疗无效时（73.2%）。对于玻璃体切除术后持续存在的DME，选择抗VEGF药物（46.3%）或类固醇（玻璃体内注射，14.6%；球后注射，36.6%）。在应用抗VEGF治疗方案时，大多数专科医生持续进行负荷注射，直到视网膜中央厚度稳定（51.4%）或视力和视网膜中央厚度均稳定（24.3%）。在维持阶段，许多专科医生根据需要进行注射（76.3%），而50.0%的医生认为“治疗-延长”方案是理想的。
我们的调查展示了日本部分视网膜专科医生对DME治疗和抗VEGF治疗实践模式的当前观点，并突出了证据与实际临床实践之间的差异或差距。
