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Diabetic Retinopathy

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17 Table 8. Management Recommendations for Patients With Diabetes Severity of Retinopathy Presence of Macular Edema Follow-up (Months) Panretinal Photocoagulation (Scatter) Laser Focal and/ or Grid Laser a Intravitreal Anti-VEGF Therapy Normal or minimal NPDR No 12 No No No Mild NPDR No 12 No No No ME 4–6 No No No CSME b 1 a No Sometimes Sometimes Moderate NPDR No 6–12 No No No ME 3–6 No No No CSME b 1 a No Sometimes Sometimes Severe NPDR No 4 Sometimes No No ME 2–4 Sometimes No No CSME b 1 a Sometimes Sometimes Sometimes Non-high- risk PDR No 4 Sometimes No No ME 4 Sometimes No No CSME b 1 a Sometimes Sometimes Sometimes High-risk PDR No 4 Recommended No Considered ME 4 Recommended Sometimes Usually CSME b 1 a Recommended Sometimes Usually a Adjunctive treatments that may be considered include intravitreal corticosteroids or anti-VEGF agents (off-label use, except aflibercept and ranibizumab). Data from the Diabetic Retinopathy Clinical Research Network in 2011 demonstrated that, at two years of follow-up, intravitreal ranibizumab with prompt or deferred laser resulted in greater visual acuity gain and intravitreal triamcinolone acetonide plus laser also resulted in greater visual gain in pseudophakic eyes compared with laser alone. Individuals receiving the intravitreal injections of anti-VEGF agents may be re- examined as early as one month following injection. b Exceptions include hypertension or fluid retention associated with heart failure, renal failure, pregnancy, or any other causes that may aggravate macular edema. Deferral of photocoagulation for a brief period of medical treatment may be considered in these cases. Also, deferral of CSME treatment is an option when the center of the macula is not involved, visual acuity is excellent, close follow-up is possible, and the patient understands the risks. Anti-VEGF, anti-vascular endothelial growth factor; CSME, clinically significant macular edema; ME, macular edema; NPDR, nonproliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy

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