Diabetic Retinopathy Medication

  • Author: Abdhish R Bhavsar, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Oct 27, 2011
 

Medication Summary

Several medications are used in an off-label manner in the treatment of diabetic retinopathy. At present, these medications are administered into the eye by intravitreal injection.

Intravitreal triamcinolone is being used in the treatment of diabetic macular edema. A recent Diabetic Retinopathy Clinical Research Network (DRCR.net) clinical trial demonstrated that although some reduction in macular edema occurred after intravitreal triamcinolone, this effect was not as robust as that achieved with focal laser treatment at the primary endpoint of 2 years.[26] In addition, intravitreal triamcinolone can have some adverse effects, including steroid response with intraocular pressure increase and cataracts.

Other medications used in clinical practice and in clinical trials include intravitreal bevacizumab (Avastin) and ranibizumab (Lucentis). These medications are VEGF antibodies and antibody fragments, respectively. They can help reduce diabetic macular edema and neovascularization of the disc or retina. Combinations of some of these medications with focal laser treatment have been investigated in the DRCR.net clinical trials and have proven efficacy, as described above.

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Corticosteroids

Class Summary

Corticosteroids inhibit inflammatory responses. They inhibit processes associated with inflammation such as edema, fibrin deposition, capillary dilation, deposition of collagen, leukocyte migration, and fibroblast and capillary proliferation.

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Triamcinolone acetonide (Triesence)

 

Triamcinolone is a synthetic corticosteroid with anti-inflammatory effects. It is indicated for several ophthalmic diseases such as ocular inflammatory conditions and visualization during vitrectomy. Intravitreal triamcinolone is also being used in the treatment of diabetic macular edema.

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Monoclonal Antibodies

Class Summary

These agents can help reduce diabetic macular edema and neovascularization of the disc or retina.

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Ranibizumab (Lucentis)

 

Ranibizumab is a recombinant humanized monoclonal antibody indicated for neovascular (wet) age-related macular degeneration (ARMD) and macular edema following retinal vein occlusion. Ranibizumab prevents the interaction of VEGF-A with its receptors (VEGFR1 and VEGFR2), suppressing neovascularization, endothelial cell proliferation, and vascular leakage.

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Contributor Information and Disclosures
Author

Abdhish R Bhavsar, MD  Adjunct Assistant Professor, Department of Ophthalmology, University of Minnesota Medical School; Director of Clinical Research, Retina Center, PA; Past Chair, Consulting Staff, Department of Ophthalmology, Phillips Eye Institute

Abdhish R Bhavsar, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, and Minnesota Medical Association

Disclosure: Allergan Grant/research funds None; genentech Grant/research funds None; regeneron Grant/research funds None; sirion Grant/research funds None; Eyetech Consulting fee Consulting; Allergan Consulting fee Consulting; regeneron Consulting

Coauthor(s)

Neal H Atebara, MD  Private Practice, Retina Center of Hawaii

Neal H Atebara, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Retina Specialists, Hawaii Medical Association, and Retina Society

Disclosure: Nothing to disclose.

John H Drouilhet, MD, FACS  Clinical Professor, Department of Surgery, Section of Ophthalmology, University of Hawaii, John A Burns School of Medicine

John H Drouilhet, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

V Al Pakalnis, MD, PhD  Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Sherman O Valero, MD, to the development and writing of this article.

References

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Fundus photograph of early background diabetic retinopathy showing multiple microaneurysms.
Retinal findings in background diabetic retinopathy, including blot hemorrhages (arrowhead), microaneurysms (short arrow), and hard exudates (long arrow).
Fluorescein angiogram demonstrating an area of capillary nonperfusion (arrow).
Fluorescein angiogram demonstrating foveal dye leakage caused by macular edema.
Fundus photograph of clinically significant macular edema demonstrating retinal exudates within the fovea.
New vessel formation on the surface of the retina (neovascularization elsewhere)
An area of neovascularization that leaks fluorescein on angiography.
Boat-shaped preretinal hemorrhage associated with neovascularization elsewhere.
Fibrovascular proliferations within the vitreous cavity
Extensive fibrovascular proliferations within and around the optic disc
 
 
 
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