Sacconi Riccardo, Giuffrè Chiara, Corbelli Eleonora, Borrelli Enrico, Querques Giuseppe, Bandello Francesco
Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milan, 20132, Italy.
F1000Res. 2019 Aug 12;8. doi: 10.12688/f1000research.19198.1. eCollection 2019.
Macular edema (ME) is a major complication of several vascular and inflammatory retinal diseases. Multiple mechanisms are implicated in its development and lead to visual impairment that could be reversible (the acute stages) or not reversible (long-standing ME). For this reason, an effective approach to the treatment of ME is of paramount importance in order to prevent irreversible damage of visual function. In this review, we discuss the management of ME and, in particular, current data of studies and clinical trials about drugs that have already been evaluated or are under investigation in the management of ME. Although several diseases could lead to the development of ME, we focus on the three main causes: diabetic retinopathy (DR), retinal vein occlusion (RVO), and uveitis. The introduction into clinical practice of anti-vascular endothelial growth factor injections (ranibizumab and aflibercept) and dexamethasone implants has revolutionized the treatment of ME secondary to DR and RVO. However, new drugs are needed in the treatment of resistant forms of ME secondary to DR and RVO. A fluocinolone acetonide implant has been approved by the US Food and Drug Administration for the treatment of diabetic ME but not for RVO. Furthermore, brolucizumab and abicipar pegol have been shown to be effective in preliminary studies and have the chance to be approved soon for diabetic ME treatment. In ME secondary to uveitis, a crucial role is played by corticosteroids and non-biologic immunomodulatory drugs. However, several new biologic agents are under investigation in different clinical trials and could be important new therapeutic options in cases with a low response to first-line therapy. However, only a few of these drugs will enter the market after proving their safety and efficacy. Only after that will we be able to offer a new therapeutic option to patients affected by uveitic ME.
黄斑水肿(ME)是几种视网膜血管性和炎症性疾病的主要并发症。其发病涉及多种机制,可导致视力损害,这种损害可能是可逆的(急性期),也可能是不可逆的(长期ME)。因此,为防止视功能发生不可逆损害,一种有效的ME治疗方法至关重要。在本综述中,我们讨论了ME的治疗,尤其是关于已被评估或正在研究用于ME治疗的药物的研究和临床试验的当前数据。尽管有几种疾病可导致ME的发生,但我们重点关注三个主要病因:糖尿病性视网膜病变(DR)、视网膜静脉阻塞(RVO)和葡萄膜炎。抗血管内皮生长因子注射剂(雷珠单抗和阿柏西普)以及地塞米松植入剂引入临床实践,彻底改变了继发于DR和RVO的ME的治疗方法。然而,在治疗继发于DR和RVO的耐药性ME时,仍需要新药。醋酸氟轻松植入剂已获美国食品药品监督管理局批准用于治疗糖尿病性ME,但未获批用于治疗RVO。此外,在初步研究中,布罗珠单抗和阿比西帕培戈已显示出有效性,并有机会很快获批用于糖尿病性ME的治疗。在继发于葡萄膜炎的ME中,皮质类固醇和非生物免疫调节药物发挥着关键作用。然而,几种新型生物制剂正在不同的临床试验中进行研究,对于一线治疗反应不佳的病例,它们可能成为重要的新治疗选择。然而,这些药物中只有少数在证明其安全性和有效性后才能进入市场。只有到那时,我们才能为受葡萄膜炎性ME影响的患者提供新的治疗选择。