Role of inflammation in diabetic macular edema and neovascular age-related macular degeneration

Surv Ophthalmol. 2024 Nov-Dec;69(6):870-881. doi: 10.1016/j.survophthal.2024.07.006. Epub 2024 Jul 18.

Abstract

Diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD) are multifactorial disorders that affect the macula and cause significant vision loss. Although inflammation and neoangiogenesis are hallmarks of DME and nAMD, respectively, they share some biochemical mediators. While inflammation is a trigger for the processes that lead to the development of DME, in nAMD inflammation seems to be the consequence of retinal pigment epithelium and Bruch membrane alterations. These pathophysiologic differences may be the key issue that justifies the difference in treatment strategies. Vascular endothelial growth factor inhibitors have changed the treatment of both diseases, however, many patients with DME fail to achieve the established therapeutic goals. From a clinical perspective, targeting inflammatory pathways with intravitreal corticosteroids has been proven to be effective in patients with DME. On the contrary, the clinical relevance of addressing inflammation in patients with nAMD has not been proven yet. We explore the role and implication of inflammation in the development of nAMD and DME and its therapeutical relevance.

Keywords: Diabetic Macular Edema; Inflammation; Intravitreal corticosteroid implant; Neovascular age-related macular degeneration; VEGF inhibitors.

Publication types

  • Review

MeSH terms

  • Angiogenesis Inhibitors / therapeutic use
  • Diabetic Retinopathy* / drug therapy
  • Diabetic Retinopathy* / physiopathology
  • Glucocorticoids / therapeutic use
  • Humans
  • Inflammation* / physiopathology
  • Intravitreal Injections
  • Macular Edema* / drug therapy
  • Macular Edema* / etiology
  • Macular Edema* / physiopathology
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Wet Macular Degeneration* / diagnosis
  • Wet Macular Degeneration* / drug therapy
  • Wet Macular Degeneration* / physiopathology

Substances

  • Angiogenesis Inhibitors
  • Glucocorticoids
  • Vascular Endothelial Growth Factor A