GUIDELINES FOR THE DIAGNOSIS AND MANAGEMENT OF DIABETIC RETINOPATHY AND DIABETIC MACULAR EDEMA IN INDONESIA Indonesian Vitreoretinal Society (INAVRS)
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Published
Sep 22, 2024
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Abstract
Diabetic retinopathy (DR) and diabetic macular edema (DME) are among the microvascular complications in individuals with diabetes mellitus (DM) that can lead to blindness if not diagnosed early and managed appropriately. Both disorders can be diagnosed and treated using a variety of techniques. Treatment modalities include laser photocoagulation therapy, vitrectomy surgery, intraocular steroid injections, and anti-vascular endothelial growth factor (anti-VEGF) injections. These methods can help avoid blindness when used in conjunction with metabolic control. These recommendations were created with the use of evidence-based medicine principles to help medical professionals—particularly ophthalmologists—identify and treat cases of DR and DME.The primary objective is to provide consensus recommendations and hopefully reduce the incidence of blindness caused by DR and DME in Indonesia.
Keywords
Diabetes, diabetic macular edema, diabetic retinopathy, laser, intravitreal injections
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How to Cite
HARLEY, Ohisa et al.
GUIDELINES FOR THE DIAGNOSIS AND MANAGEMENT OF DIABETIC RETINOPATHY AND DIABETIC MACULAR EDEMA IN INDONESIA.
International Journal of Retina, [S.l.], v. 7, n. 2, p. 168, sep. 2024.
ISSN 2614-8536.
Available at: <https://ijretina.com/index.php/ijretina/article/view/300>. Date accessed: 21 dec. 2024.
doi: https://doi.org/10.35479/ijretina.2024.vol007.iss002.300.
Section
Article Review
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
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6. World Health Organization. Diabetic Retinopathy Screening: A Short Guide. Increase Effectiveness, Maximize Benefits and Minimize Harm. Copenhagen: WHO Regional Office for Europe; 2020.
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9. Goh JKH, Cheung CY, Sim SS, Tan PC, Tan GSW, Wong TY. Retinal imaging techniques for diabetic retinopathy screening. J Diabetes Sci Technol. 2016;10(2):282-94.
10. Horie S, Ohno-Matsui K. Progress of imaging in diabetic retinopathy—from the past to the present. Diagnostics. 2022; 12(7):1684.
11. Hirano T, Imai A, Kasamatsu H, Kakihara S, Toriyama Y, Murata T. Assessment of diabetic retinopathy using two ultra-wide-field fundus imaging systems, the Clarus® and Optos™ systems. BMC Ophthalmol. 2018;18(1):332.
12. Panozzo G, Cicinelli MV, Augustin AJ, Battaglia Parodi M, Cunha-Vaz J, Guarnaccia G, et al. An optical coherence tomography-based grading of diabetic maculopathy proposed by an international expert panel: The European School for Advanced Studies in Ophthalmology classification. Eur J Ophthalmol. 2020;30(1):8-18.
13. Lin A, Xia H, Zhang A, Liu X, Chen H. Vitreomacular interface disorders in proliferative diabetic retinopathy: an optical coherence tomography study. J Clin Med. 2022;11(12):3266.
14. Lee J, Rosen R. Optical coherence tomography angiography in diabetes. Curr Diab Rep. 2016;16(12):123.
15. Attia Ali Ahmed M, Shawkat Abdelhaleem A. Evaluation of microvascular and visual acuity changes in patients with early diabetic retinopathy: optical coherence tomography angiography study. Clin Ophthalmol. 2022;16:429-40.
16. Salz DA, Witkin AJ. Imaging in diabetic retinopathy. Middle East Afr J Ophthalmol. 2015;22(2):145-50.
17. Mohamed IE, Mohamed MA, Yousef M, Mahmoud MZ, Alonazi B. Use of ophthalmic B-scan ultrasonography in determining the causes of low vision in patients with diabetic retinopathy. Eur J Radiol Open. 2018;5:79-86.
18. Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy: ETDRS report number 9. Ophthalmology. 1991;98(5 Suppl):766-85.
19. Bhattacharyya B. Chapter 2: Panretinal Photocoagulation (PRP) in Diabetic Retinopathy. In: Step by Step Laser in Ophtalmology [internet]. India: Jaypee Brothers Medical Publishers LTD;2009 [cited Oct 2023]. p.27. Available from: https://archive.org/details/StepByStepLaserInOphthalmology/page/n38/mode/1up.
20. Constantin BD, Andrei B, Andreea M. Vitrectomy surgery of diabetic retinopathy complications. Rom J Ophthalmol. 2016;60(1):31-6.
21. De Maria M, Panchal B, Coassin M. Update on indications for diabetic vitrectomy and management of complications. Ann Eye Sci. 2018;3(9):51.
22. Rinaldi M, dell'Omo R, Morescalchi F, Semeraro F, Gambicorti E, Cacciatore F, et al. ILM peeling in nontractional diabetic macular edema: review and metanalysis. Int Ophthalmol. 2018;38(6):2709-14.
23. Wang DY, Zhao XY, Zhang WF, Meng LH, Chen YX. Perioperative anti-vascular endothelial growth factor agents treatment in patients undergoing vitrectomy for complicated proliferative diabetic retinopathy: a network meta-analysis. Sci Rep. 2020;10(1):18880.
24. International Council of Ophthalmology. ICO Guidelines for Diabetic Eye Care. USA;2017. p.1-2.
25. Baker CW, Glassman AR, Beaulieu WT, Antoszyk AN, Browning DJ, Chalam KV, et al; DRCR Retina Network. Effect of initial anagement with aflibercept vs laser photocoagulation vs observation on vision loss among patients with diabetic macular edema involving the center of the macula and good visual acuity: a randomized clinical trial. JAMA. 2019;321(19):1880–94.
26. Wells JA, Glassman AR, Ayala AR, Jampol LM, Bressler NM, Bressler SB, et al. Diabetic Retinopathy Clinical Research Network. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema: two-year results from a comparative effectiveness randomized clinical trial. Ophthalmology. 2016;123(6):1351–59.
27. Do DV. Aflibercept 8 mg for diabetic macular edema: 48-week results from the phase 2/3 PHOTON trial. Invest Ophthalmol Vis Sci. 2023;64(8):2814.
28. Brown DM, Emanuelli A, Bandello F, Barranco JJE, Figueira J, Souied E, et al. KESTREL and KITE: 52-week results from two phase III pivotal trials of brolucizumab for diabetic macular edema. Am J Ophthalmol. 2022;238:157-72.
29. Wykoff CC, Garweg JG, Regillo C, Souied E, Wolf S, Dhoot DS, et al. KESTREL and KITE phase 3 studies: 100-week results with brolucizumab in patients with diabetic macular edema. Am J Ophthalmol. 2023:S0002-9394(23)00291-X.
30. Wykoff CC, Abreu F, Adamis AP, Basu K, Eichenbaum DA, Haskova Z, et al; YOSEMITE and RHINE Investigators. Efficacy, durability, and safety of intravitreal faricimab with extended dosing up to every 16 weeks in patients with diabetic macular oedema (YOSEMITE and RHINE): two randomised, double-masked, phase 3 trials. Lancet. 2022;399(10326):741-55.
31. Eter N, Singh RP, Abreu F, Asik K, Basu K, Baumal C, et al. YOSEMITE and RHINE: phase 3 randomized clinical trials of faricimab for diabetic macular edema: study design and rationale. Ophthalmol Sci. 2021;2(1):100111.
32. Jhaveri CD, Glassman AR, Ferris FL 3rd, Liu D, Maguire MG, Allen JB, et al; DRCR Retina Network. Aflibercept monotherapy or bevacizumab first for diabetic macular edema. N Engl J Med. 2022;387(8):692-703.
33. Korobelnik JF, Daien V, Faure C, Tadayoni R, Giocanti-Aurégan A, Dot C, et al; APOLLON study investigators. Two-year outcomes of the APOLLON observational study of intravitreal aflibercept monotherapy in France in patients with diabetic macular edema. Sci Rep. 2022;12(1):18242.
34. Garweg JG, Štefanickova J, Hoyng C, Niesen T, Schmelter T, Leal S, et al; VIOLET Investigators. Dosing regimens of intravitreal aflibercept for diabetic macular edema beyond the first year: violet, a prospective randomized trial. Adv Ther. 2022;39(6):2701-16.
35. Maturi RK, Glassman AR, Liu D, Beck RW, Bhavsar AR, Bressler NM, et al; Diabetic Retinopathy Clinical Research Network. Effect of adding dexamethasone to continued ranibizumab treatment in patients with persistent diabetic macular edema: a DRCR network phase 2 randomized clinical trial. JAMA Ophthalmol. 2018;136(1):29-38.
36. Heier JS, Korobelnik J-F, Brown DM, Schmidt-Erfurth U, Do DV, Midena E, et al. Intravitreal aflibercept for diabetic macular edema: 148-week results from the VISTA and VIVID studies. Ophthalmology. 2016;123(11):2376–85.
37. Brown DM, Schmidt-Erfurth U, Do DV, Holz FG, Boyer DS, Midena E, et al. Intravitreal aflibercept for diabetic macular edema: 100-week results from the vista and vivid studies. Ophthalmology. 2015;122(10):2044-52.
38. Ishibashi T, Li X, Koh A, Lai TY, Lee FL, Lee WK, Ma Z, Ohji M, Tan N, Cha SB, Shamsazar J, Yau CL; REVEAL Study Group. The REVEAL study: ranibizumab monotherapy or combined with laser versus laser monotherapy in asian patients with diabetic macular edema. Ophthalmology. 2015;122(7):1402-15.
39. Prünte C, Fajnkuchen F, Mahmood S, Ricci F, Hatz K, Studnička J, et al; RETAIN Study Group. Ranibizumab 0.5 mg treat-and-extend regimen for diabetic macular oedema: the RETAIN study. Br J Ophthalmol. 2016;100(6):787-95.
40. Rajendram R, Fraser-Bell S, Kaines A, Michaelides M, Hamilton RD, Esposti SD, et al. A 2-year prospective randomized controlled trial of intravitreal bevacizumab or laser therapy (BOLT) in the management of diabetic macular edema: 24-month data: report 3. Arch Ophthalmol. 2012;130(8):972-9.
41. Nguyen QD, Brown DM, Marcus DM, Boyer DS, Patel S, Feiner L, et al. RISE and RIDE Research Group. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012;119(4):789–801.
42. Bressler NM, Varma R, Suñer IJ, Dolan CM, Ward J, Ehrlich JS, et al; RIDE and RISE Research Groups. Vision-related function after ranibizumab treatment for diabetic macular edema: results from RIDE and RISE. Ophthalmology. 2014;121(12):2461-72.
43. Mitchell P, Bandello F, Schmidt-Erfurth U, Lang GE, Massin P, Schlingemann RO, et al; RESTORE study group. The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology. 2011;118(4):615-25.
44. Nguyen QD, Shah SM, Khwaja AA, Channa R, Hatef E, Do DV, et al; READ-2 Study Group. Two-year outcomes of the ranibizumab for edema of the macula in diabetes (READ-2) study. Ophthalmology. 2010;117(11):2146-51.
45. Massin P, Bandello F, Garweg JG, Hansen LL, Harding SP, Larsen M, et al. Safety and efficacy of ranibizumab in diabetic macular edema (RESOLVE Study): a 12-month, randomized, controlled, double-masked, multicenter phase II study. Diabetes Care. 2010;33(11):2399-405.
46. Elman MJ, Bressler NM, Qin H, Beck RW, Ferris FL 3rd, Friedman SM, et al; Diabetic Retinopathy Clinical Research Network. Expanded 2-year follow-up of ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2011;118(4):609-14.
47. Diabetic Retinopathy Clinical Research Network. A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology. 2008;115(9):1447-9, 1449.e1-10.
2. Sasongko MB, Widyaputri F, Agni AN, Wardhana FS, Kotha S, Gupta P, et al. Prevalence of diabetic retinopathy and blindness in Indonesian adults with type 2 diabetes. Am J Ophthalmol. 2017;181:79-87.
3. American Academy of Ophthalmology. Basic and Clinical Science Course: Retina and Vitreous 2020-2021. AAO; 2021.
4. Tan GS, Cheung N, Simó R, Cheung GC, Wong TY. Diabetic macular oedema. Lancet Diabetes Endocrinol. 2017;5(2):143-155.
5. Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, et al. Diabetic retinopathy preferred practice pattern®. Ophthalmology. 2020;127(1):P66-145.
6. World Health Organization. Diabetic Retinopathy Screening: A Short Guide. Increase Effectiveness, Maximize Benefits and Minimize Harm. Copenhagen: WHO Regional Office for Europe; 2020.
7. Wong TY, Cheung CM, Larsen M, Sharma S, Simó R. Diabetic retinopathy. Nat Rev Dis Primers. 2016;2:16012.
8. Nguyen NV, Vigil EM, Hassan M, Halim MS, Baluyot SC, Guzman HA, et al. Comparison of montage with conventional stereoscopic seven-field photographs for assessment of ETDRS diabetic retinopathy severity. Int J Retina Vitreous. 2019;5:51.
9. Goh JKH, Cheung CY, Sim SS, Tan PC, Tan GSW, Wong TY. Retinal imaging techniques for diabetic retinopathy screening. J Diabetes Sci Technol. 2016;10(2):282-94.
10. Horie S, Ohno-Matsui K. Progress of imaging in diabetic retinopathy—from the past to the present. Diagnostics. 2022; 12(7):1684.
11. Hirano T, Imai A, Kasamatsu H, Kakihara S, Toriyama Y, Murata T. Assessment of diabetic retinopathy using two ultra-wide-field fundus imaging systems, the Clarus® and Optos™ systems. BMC Ophthalmol. 2018;18(1):332.
12. Panozzo G, Cicinelli MV, Augustin AJ, Battaglia Parodi M, Cunha-Vaz J, Guarnaccia G, et al. An optical coherence tomography-based grading of diabetic maculopathy proposed by an international expert panel: The European School for Advanced Studies in Ophthalmology classification. Eur J Ophthalmol. 2020;30(1):8-18.
13. Lin A, Xia H, Zhang A, Liu X, Chen H. Vitreomacular interface disorders in proliferative diabetic retinopathy: an optical coherence tomography study. J Clin Med. 2022;11(12):3266.
14. Lee J, Rosen R. Optical coherence tomography angiography in diabetes. Curr Diab Rep. 2016;16(12):123.
15. Attia Ali Ahmed M, Shawkat Abdelhaleem A. Evaluation of microvascular and visual acuity changes in patients with early diabetic retinopathy: optical coherence tomography angiography study. Clin Ophthalmol. 2022;16:429-40.
16. Salz DA, Witkin AJ. Imaging in diabetic retinopathy. Middle East Afr J Ophthalmol. 2015;22(2):145-50.
17. Mohamed IE, Mohamed MA, Yousef M, Mahmoud MZ, Alonazi B. Use of ophthalmic B-scan ultrasonography in determining the causes of low vision in patients with diabetic retinopathy. Eur J Radiol Open. 2018;5:79-86.
18. Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy: ETDRS report number 9. Ophthalmology. 1991;98(5 Suppl):766-85.
19. Bhattacharyya B. Chapter 2: Panretinal Photocoagulation (PRP) in Diabetic Retinopathy. In: Step by Step Laser in Ophtalmology [internet]. India: Jaypee Brothers Medical Publishers LTD;2009 [cited Oct 2023]. p.27. Available from: https://archive.org/details/StepByStepLaserInOphthalmology/page/n38/mode/1up.
20. Constantin BD, Andrei B, Andreea M. Vitrectomy surgery of diabetic retinopathy complications. Rom J Ophthalmol. 2016;60(1):31-6.
21. De Maria M, Panchal B, Coassin M. Update on indications for diabetic vitrectomy and management of complications. Ann Eye Sci. 2018;3(9):51.
22. Rinaldi M, dell'Omo R, Morescalchi F, Semeraro F, Gambicorti E, Cacciatore F, et al. ILM peeling in nontractional diabetic macular edema: review and metanalysis. Int Ophthalmol. 2018;38(6):2709-14.
23. Wang DY, Zhao XY, Zhang WF, Meng LH, Chen YX. Perioperative anti-vascular endothelial growth factor agents treatment in patients undergoing vitrectomy for complicated proliferative diabetic retinopathy: a network meta-analysis. Sci Rep. 2020;10(1):18880.
24. International Council of Ophthalmology. ICO Guidelines for Diabetic Eye Care. USA;2017. p.1-2.
25. Baker CW, Glassman AR, Beaulieu WT, Antoszyk AN, Browning DJ, Chalam KV, et al; DRCR Retina Network. Effect of initial anagement with aflibercept vs laser photocoagulation vs observation on vision loss among patients with diabetic macular edema involving the center of the macula and good visual acuity: a randomized clinical trial. JAMA. 2019;321(19):1880–94.
26. Wells JA, Glassman AR, Ayala AR, Jampol LM, Bressler NM, Bressler SB, et al. Diabetic Retinopathy Clinical Research Network. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema: two-year results from a comparative effectiveness randomized clinical trial. Ophthalmology. 2016;123(6):1351–59.
27. Do DV. Aflibercept 8 mg for diabetic macular edema: 48-week results from the phase 2/3 PHOTON trial. Invest Ophthalmol Vis Sci. 2023;64(8):2814.
28. Brown DM, Emanuelli A, Bandello F, Barranco JJE, Figueira J, Souied E, et al. KESTREL and KITE: 52-week results from two phase III pivotal trials of brolucizumab for diabetic macular edema. Am J Ophthalmol. 2022;238:157-72.
29. Wykoff CC, Garweg JG, Regillo C, Souied E, Wolf S, Dhoot DS, et al. KESTREL and KITE phase 3 studies: 100-week results with brolucizumab in patients with diabetic macular edema. Am J Ophthalmol. 2023:S0002-9394(23)00291-X.
30. Wykoff CC, Abreu F, Adamis AP, Basu K, Eichenbaum DA, Haskova Z, et al; YOSEMITE and RHINE Investigators. Efficacy, durability, and safety of intravitreal faricimab with extended dosing up to every 16 weeks in patients with diabetic macular oedema (YOSEMITE and RHINE): two randomised, double-masked, phase 3 trials. Lancet. 2022;399(10326):741-55.
31. Eter N, Singh RP, Abreu F, Asik K, Basu K, Baumal C, et al. YOSEMITE and RHINE: phase 3 randomized clinical trials of faricimab for diabetic macular edema: study design and rationale. Ophthalmol Sci. 2021;2(1):100111.
32. Jhaveri CD, Glassman AR, Ferris FL 3rd, Liu D, Maguire MG, Allen JB, et al; DRCR Retina Network. Aflibercept monotherapy or bevacizumab first for diabetic macular edema. N Engl J Med. 2022;387(8):692-703.
33. Korobelnik JF, Daien V, Faure C, Tadayoni R, Giocanti-Aurégan A, Dot C, et al; APOLLON study investigators. Two-year outcomes of the APOLLON observational study of intravitreal aflibercept monotherapy in France in patients with diabetic macular edema. Sci Rep. 2022;12(1):18242.
34. Garweg JG, Štefanickova J, Hoyng C, Niesen T, Schmelter T, Leal S, et al; VIOLET Investigators. Dosing regimens of intravitreal aflibercept for diabetic macular edema beyond the first year: violet, a prospective randomized trial. Adv Ther. 2022;39(6):2701-16.
35. Maturi RK, Glassman AR, Liu D, Beck RW, Bhavsar AR, Bressler NM, et al; Diabetic Retinopathy Clinical Research Network. Effect of adding dexamethasone to continued ranibizumab treatment in patients with persistent diabetic macular edema: a DRCR network phase 2 randomized clinical trial. JAMA Ophthalmol. 2018;136(1):29-38.
36. Heier JS, Korobelnik J-F, Brown DM, Schmidt-Erfurth U, Do DV, Midena E, et al. Intravitreal aflibercept for diabetic macular edema: 148-week results from the VISTA and VIVID studies. Ophthalmology. 2016;123(11):2376–85.
37. Brown DM, Schmidt-Erfurth U, Do DV, Holz FG, Boyer DS, Midena E, et al. Intravitreal aflibercept for diabetic macular edema: 100-week results from the vista and vivid studies. Ophthalmology. 2015;122(10):2044-52.
38. Ishibashi T, Li X, Koh A, Lai TY, Lee FL, Lee WK, Ma Z, Ohji M, Tan N, Cha SB, Shamsazar J, Yau CL; REVEAL Study Group. The REVEAL study: ranibizumab monotherapy or combined with laser versus laser monotherapy in asian patients with diabetic macular edema. Ophthalmology. 2015;122(7):1402-15.
39. Prünte C, Fajnkuchen F, Mahmood S, Ricci F, Hatz K, Studnička J, et al; RETAIN Study Group. Ranibizumab 0.5 mg treat-and-extend regimen for diabetic macular oedema: the RETAIN study. Br J Ophthalmol. 2016;100(6):787-95.
40. Rajendram R, Fraser-Bell S, Kaines A, Michaelides M, Hamilton RD, Esposti SD, et al. A 2-year prospective randomized controlled trial of intravitreal bevacizumab or laser therapy (BOLT) in the management of diabetic macular edema: 24-month data: report 3. Arch Ophthalmol. 2012;130(8):972-9.
41. Nguyen QD, Brown DM, Marcus DM, Boyer DS, Patel S, Feiner L, et al. RISE and RIDE Research Group. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012;119(4):789–801.
42. Bressler NM, Varma R, Suñer IJ, Dolan CM, Ward J, Ehrlich JS, et al; RIDE and RISE Research Groups. Vision-related function after ranibizumab treatment for diabetic macular edema: results from RIDE and RISE. Ophthalmology. 2014;121(12):2461-72.
43. Mitchell P, Bandello F, Schmidt-Erfurth U, Lang GE, Massin P, Schlingemann RO, et al; RESTORE study group. The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology. 2011;118(4):615-25.
44. Nguyen QD, Shah SM, Khwaja AA, Channa R, Hatef E, Do DV, et al; READ-2 Study Group. Two-year outcomes of the ranibizumab for edema of the macula in diabetes (READ-2) study. Ophthalmology. 2010;117(11):2146-51.
45. Massin P, Bandello F, Garweg JG, Hansen LL, Harding SP, Larsen M, et al. Safety and efficacy of ranibizumab in diabetic macular edema (RESOLVE Study): a 12-month, randomized, controlled, double-masked, multicenter phase II study. Diabetes Care. 2010;33(11):2399-405.
46. Elman MJ, Bressler NM, Qin H, Beck RW, Ferris FL 3rd, Friedman SM, et al; Diabetic Retinopathy Clinical Research Network. Expanded 2-year follow-up of ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2011;118(4):609-14.
47. Diabetic Retinopathy Clinical Research Network. A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology. 2008;115(9):1447-9, 1449.e1-10.