From the Guidelines
Macular lesions should be treated with intravitreal anti-VEGF agents, as they provide more effective treatment for center-involved diabetic macular edema than monotherapy with laser, with aflibercept being the preferred agent for eyes with moderate visual impairment. The management of macular lesions, particularly those related to diabetic macular edema, has evolved significantly with the introduction of anti-VEGF therapy. According to the most recent guidelines from 2025 1, intravitreal anti-VEGF agents such as ranibizumab, aflibercept, and bevacizumab are the preferred treatment for center-involved diabetic macular edema.
Key Considerations
- The choice of anti-VEGF agent may depend on the severity of visual impairment, with aflibercept demonstrating superior vision outcomes for eyes with moderate visual impairment (vision of 20/50 or worse) 1.
- For eyes with good vision (20/25 or better) despite diabetic macular edema, close monitoring with initiation of anti-VEGF therapy if vision worsens may provide similar 2-year vision outcomes to immediate initiation of anti-VEGF therapy 1.
- Eyes that have persistent diabetic macular edema despite anti-VEGF treatment may benefit from macular laser photocoagulation or intravitreal therapy with corticosteroids 1.
Treatment Approach
- Intravitreal anti-VEGF injections are typically administered every 4-8 weeks during the first 12 months of treatment, with fewer injections needed in subsequent years to maintain remission from center-involved diabetic macular edema 1.
- Regular monitoring with OCT (Optical Coherence Tomography) imaging is essential for tracking progression and treatment response.
- The presence of retinopathy is not a contraindication to aspirin therapy for cardioprotection, as aspirin does not increase the risk of retinal hemorrhage 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Macular Lesions
- Macular lesions are a common cause of vision loss, particularly in older adults, and can be caused by various factors, including age-related macular degeneration (AMD) 2, 3.
- Neovascular AMD is a type of AMD that is characterized by the growth of new, fragile blood vessels under the macula, which can lead to vision loss 3, 4.
- Anti-vascular endothelial growth factor (anti-VEGF) agents, such as ranibizumab, aflibercept, and bevacizumab, are commonly used to treat neovascular AMD by blocking the growth of new blood vessels and reducing inflammation 2, 3, 5, 6.
Treatment Options
- Intravitreal injections of anti-VEGF agents are a common treatment for neovascular AMD, and can be administered on a monthly or as-needed basis 2, 3, 5.
- Combination therapy, such as photodynamic therapy with anti-VEGF agents, may also be effective in treating neovascular AMD 2, 5.
- The choice of anti-VEGF agent and treatment regimen may depend on various factors, including the severity of the disease, the patient's medical history, and the presence of other eye conditions 3, 4, 5.
Outcomes
- Anti-VEGF treatment has been shown to improve visual acuity and reduce the risk of vision loss in patients with neovascular AMD 2, 3, 5.
- The visual acuity outcomes of anti-VEGF treatment can vary depending on the specific agent and treatment regimen used, as well as the severity of the disease 3, 5.
- Long-term treatment with anti-VEGF agents may be necessary to maintain visual acuity and prevent disease progression 3, 5, 6.