Discussants:
Roy D Brod, MD
Harry W Flynn, Jr, MD
Carol M Lee, MD
Dr Flynn noted that patients with untreated clinically significant macular edema (CSME) had a 32% risk of developing moderate visual loss (≥3 lines) after 3 years, so accurate diagnosis is critical. He mentioned that the Bascom-Palmer Eye Institute uses optical coherence tomography (OCT) for treatment planning. He estimated that Bascom-Palmer currently performs 10 OCT exams for each fluorescein angiography exam.
Dr Flynn does not recommend the use of intravitreal triamcinolone for CSME unless at least 2 grid photocoagulation procedures have been performed previously and visual acuity is 20/80 or worse. He will not inject triamcinolone if visual acuity is 20/40 or better.
Dr Flynn also noted that bevacizumab, a vascular endothelial growth factor inhibitor, only works on CSME about half the time. The panelists stated that bevacizumab works better for clearing vitreous hemorrhage than hyaluronidase.
The panelists mentioned that protein kinase C inhibitors will probably have a role in slowing the progression of nonproliferative diabetic retinopathy.
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