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Lise Qu, Franck Fajnkuchen, Gilles Chaine, Audrey Giocanti; Diabetic macular edema treatment management by french retinal specialists. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3280.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the clinical practice of french vitreoretinal (VR) specialists in the treatment of diabetic macular edema (DME).
A 31-item survey investigating real life practice in diagnosis and treatment of DME was mailed to specialists identified from the Société Française d’Ophtalmologie and the Club Francophone des Spécialistes de la Rétine. Answers were analysed anonymously by an online survey software.
95 specialists answered the survey. 61% and 32% of respondents initiated a treatment when visual acuity (VA) was lower than 20/32 and 20/40 (Snellen chart) respectively. All the specialists used optical coherence tomography to diagnose a DME and 40% did as well a fluorescein angiography. The three determinant factors in the choice of the treatment were VA improvement, retinal anatomic improvement, and possibility of monthly monitoring. The first-line therapy option for a focal DME away from the macular center was photocoagulation for 94% of responders. For a central DME in phakic eyes, 55,8%, 25,3% and 12,3% of respondents chose respectively intravitreal (IVT) ranibizumab, aflibercept and dexamethasone implant as first line treatment. In pseudo-phakic eyes, 41%, 16,5%, 35,6% of respondents chose ranibizumab, aflibercept and dexamethasone implant respectively in first line treatment. 85% of respondents initiated the anti-VEGF therapy by 3 monthly injections, then Pro Re Nata strategy was used (37%). 42% of responders did not use antibiotic prophylaxis for IVT injections. 85% of responders usually practiced bilateral IVT injections in the same day for a same patient in case of bilateral DME.
Anti-VEGF injections were the first choice treatment in DME. Most specialists initiated the treatment with a VA at 20/32 in France while the official guidelines recommend to initiate the treatment when VA is ≤ 20/40, which is also the reimbursement threshold for the French social security system in case of DME.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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