Consensus on managing center-involving diabetic macular edema in Hong Kong: perspective

Diabetic macular edema is a common cause of vision loss in the working-age population, and its prevalence is increasing in Asian countries. Managing diabetic macular edema encompasses effective control of systemic factors and intraocular treatment including anti-vascular endothelial growth factor therapy, corticosteroid implants, and laser photocoagulation. Based on several guidelines and the available evidence, we present consensus on managing diabetic macular edema in Hong Kong to ensure optimal anatomical and visual outcomes. Although anti-vascular endothelial growth factor agents are recommended first-line treatment for patients with diabetic macular edema experiencing vision loss; however, the frequent dosing regimen imposes great clinical and patient burden. Longer-acting anti-vascular endothelial growth factor agents are needed to allow forendothelial longer intervals between treatments. As demonstrated in the KITE and KESTREL studies, brolucizumab, an antivascular endothelial growth factor A agent, is associated with fewer cases of intraretinal or subretinal fluid than aflibercept, despite fewer injections. Similarly, faricimab, a bispecific antibody targeting both vascular endothelial growth factor A and angiopoietin-2, demonstrated comparable vision gains with longer treatment intervals and larger improvements in anatomical outcome in the YOSEMITE and RHINE trials. Early intensive antivascular endothelial growth factor therapy leads to greater improvements in visual acuity and anatomical outcomes. Patients who respond inadequately to anti-vascular endothelial growth factor therapy, as monitored by optical coherence tomography, should switch treatment modality.