The Significance of Anti-Vascular Endothelial Growth Factor Therapy in Patients with Diabetic Macular Edema

Abstract

According to the recent findings of the International Diabetes Federation (IDF) in 2019, the global prevalence of diabetes mellitus (DM) is estimated to involve 463 million people in the age category between 20 and 79 years. In 2030, this number is predicted to reach 578 million people worldwide which accounts for an increase by 10% [1]. This rapidly growing number tackles the global health care institutions with challenges. Especially the eye care professionals and the enhancement of medical screening programs will gain even more importance than ever before [2]. The most prevalent microvascular complication of patients suffering from DM is diabetic retinopathy (DR) [3]. This worldwide accounts for the fifth leading cause of visual impairment and the fourth leading cause of blindness as reported by the World Health Organization in 2015 [4]. In Europe DR is even the most frequent cause of blindness, accounting for a total of 1.9% of all diabetic patients [5]. The severity of DR is a powerful predictor of risk for further progression and vision loss. The Disease Severity Scale for DR is a grading system based on the fundus findings observable on dilated ophthalmoscopy. According to that DR can be classified into mild nonproliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR and proliferative DR [6]. At any time of the disease course DR can progress to diabetic macular edema (DME), with an incidence of 2.19% per year. DME refers to an accumulation of fluid in the retinal layers. The pathophysiology is a complex and multifactorial process which involves mainly the disruption of the blood-retinal barrier (BRB) which alongside is brought up by hyperglycaemia maintained over time [5].

According to the recent findings of the International Diabetes Federation (IDF) in 2019, the global prevalence of diabetes mellitus (DM) is estimated to involve 463 million people in the age category between 20 and 79 years. In 2030, this number is predicted to reach 578 million people worldwide which accounts for an increase by 10% [1]. This rapidly growing number tackles the global health care institutions with challenges. Especially the eye care professionals and the enhancement of medical screening programs will gain even more importance than ever before [2]. The most prevalent microvascular complication of patients suffering from DM is diabetic retinopathy (DR) [3]. This worldwide accounts for the fifth leading cause of visual impairment and the fourth leading cause of blindness as reported by the World Health Organization in 2015 [4]. In Europe DR is even the most frequent cause of blindness, accounting for a total of 1.9% of all diabetic patients [5]. The severity of DR is a powerful predictor of risk for further progression and vision loss. The Disease Severity Scale for DR is a grading system based on the fundus findings observable on dilated ophthalmoscopy. According to that DR can be classified into mild nonproliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR and proliferative DR [6]. At any time of the disease course DR can progress to diabetic macular edema (DME), with an incidence of 2.19% per year. DME refers to an accumulation of fluid in the retinal layers. The pathophysiology is a complex and multifactorial process which involves mainly the disruption of the blood-retinal barrier (BRB) which alongside is brought up by hyperglycaemia maintained over time [5].