The use of intravitreal AntiVEGF for DME

Dr.Mustafa Hasoun (January 1991) is a Syrian ophthalmologist.He graduated with a Doctor of medicine degree from Tishreen University Latakia- Syria in 2015, Obtained 3 certificates from the International Council of Ophthalmology in 2019 and 2020 with Distinction degree (Top 0.1 %), Membership of Royal college of Surgeon of Edinburgh -UK (MRCSEd) in 2021 and completed a Master training programme in ophthalmology (MSc) in Tishreen university Hospital in same year, obtained a certificate of Syrian Board  of ophthalmology in 2021. Currently He is working as ophthalmologist in Latakia city- Syria.

The use of intravitreal steroids for DME

Dr. Quratulain Paracha is a Dow Graduate, did my fellowship (FCPS) in Ophthalmology from College of Physicians and Surgeons Pakistan in 2004. I initially established the eye services at Marie Adelaide Leprosy center, then joined as faculty of Ophthalmology. Currently am Associate Professor at Fazaia Ruth Pfau Medical College and FCPS supervisor at CPSP. My interest areas are anterior segment, medical Retina, Oculoplastics. I also have great interest in medical education, have more than 10 years of experience teaching undergraduates. Recently I have done Certificate of Health Profession Education.

The verdict by Ameen Marashi in the rational use of intravitreal AntiVEGF vs Steroids for DME

Dr.Ameen Marashi (born December 9, 1983) is a Syrian ophthalmologist and retina specialist.He has published a number of books and research articles in the field of retina and is the Al-Marashi Clinics Group owner.He graduated with a Diploma degree in Medicine from the Chuvash State University Institute of Medicine in 2008, and a certificate from the International Council of Ophthalmology in 2013, and completed a specialization in ophthalmology in Tartous Hospitals in 2009, and from 2010 until 2013 in Aleppo, and obtained a certificate Syrian Board 2016.

Expert opinion in the use of intravitreal AntiVEGF vs Steroids in clinical practice for DME

Dr. Hina Khan currently works as a consultant ophthalmologist at Amanat Eye Hospital. She is the lead of medical retina service and heads the retinal imaging centres at all branches of the hospital. She has over 14 yrs of experience in ophthalmology and takes keen interest in diabetic eye disease and uveitis .

Meeting Summary 

For intravitreal AntiVEGF round:

Anti-VEGF therapy is an effective and safe for naive, denovo, and refractory DME. It is cost-effective using Bevacizumab, and you may gain better visual acuity outcomes by using Ranibizumab or Aflibercept in cases are presented with worse visual acuity at baseline. In addition, intravitreal Anti-VEGF may improve DR status. Finally, there are promising results in newly approved Anti-VEGF agents in terms of the durability of the treatment.

For intravitreal steroids round:

In DME, beneficial gain of steroids is achieved by appropriate patient selection. The timing of injecting and switching from anti-VEGF agent steroids may add durability and cost benefits but with an increased risk of IOP spikes and cataract. 

For expert opinion round: 

Whether to use anti-VEGF or steroids in a case of DME is an important question. An equally important question is when to shift from one agent to the other.

For verdict round: 

• Intravitreal AntiVEGF as a first-line therapy for cases of central DME with BCVA 20/32

• Start with a loading dose of intravitreal AntiVEGF for three to five injections four weeks apart (except for every six weeks)

• Follow up using a treat and extend.

• Intravitreal steroids are used as a second-line therapy for cases that are not responsive or /and contraindicated for intravitreal Anti-VEGF.

• Follow up using PRN.

• Keep in mind that intravitreal steroids may increase IOP and cataract formation.