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CME Monograph


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FORMAT: Monograph

ORIGINAL RELEASE: December 1, 2019
EXPIRATION: December 31, 2020

MAXIMUM CREDITS: 1.5 AMA PRA Category 1 Credits

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PURPOSE
By 2030, the prevalence of diabetes is expected to increase by over 50% to affect 55 million Americans. With this increase comes a significant challenge for clinicians to help prevent blindness due to diabetic eye disease for a growing number of patients. Although the advent of anti–vascular endothelial growth factor intravitreal injection revolutionized treatment of diabetic eye disease, including diabetic retinopathy and diabetic macular edema, a considerable proportion of patients with vision-threatening diabetic macular edema do not respond satisfactorily to treatment. Accumulating research suggests a multifactorial disease pathogenesis in these patients, with a strong inflammatory component driving progression in concert with abnormal angiogenesis. Corticosteroid treatment with the dexamethasone implant, fluocinolone acetonide implant, or triamcinolone intravitreal injection (used off-label) can improve outcomes for patients with persistent diabetic macular edema, provided that considering a switch in treatment does not come too late in the disease process. Selecting a corticosteroid should consider available evidence and pharmacologic differences that can affect the relative efficacy and safety of each for individual patients.

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CME Monograph