Real clinical practice in the management of the diabetic macular edema in Spain. DME challenge

Session Details

Session Title: Free Paper Session 2: Vascular Diseases & Diabetic Retinopathy I

Session Date/Time: Thursday 07/09/2017 | 09:00-10:30

Paper Time: 09:06

Venue: Room 117

First Author: : J.Donate SPAIN

Co Author(s): :    R. Abreu Gonzalez   R. Gallego-Pina   M. Abraldes Lopez-Veiga   F. Lavid de los Mozos   M. Lopez Galvez   J. Olea Vallejo              

Abstract Details

Purpose:

To analyze retrospectively in hospitals of the different regions in Spain, the management of DME (Diabetic macular edema), to confront it with the therapeutic guides accepted in our environment and to propose improvements that approach us to the solutions to the handling of the problem in each one of the territories

Setting:

A group of 17 experts was formed, representing the different regions of Spain. Each led the data collection in their centres and transferred the results to the group and the final conclusions to its work exchange.

Methods:

Each of the researchers collected data retrospectively from about 25 patients treated with antivegf (ranibizumab) with at least one year of follow-up. The ETDRS visual acuity is the main variable and, the centre thickness (CST), central macualr volume (CMV), qualitative changes in OCT at 3, 6 and 12 months are the secondary variables of clinical exploration. We also evaluated the guidelines in the diagnosis of diabetes, patterns of treatment followed as well as the identified adverse effects. A Delphi survey was carried out in each area with the aspects related to the diagnosis, treatment and follow-up of EMD in which 137 specialists from all over Spain participated. The results were exposed in local workshops and analyzed deviations on therapeutic guides. The conclusions of each of the groups were put together with the group of experts

Results:

The visual acuity variation was mean 5 ETDRS letters and the change in CST -61 microns. The chosen guideline is Treat and extend although the application of the treatments was very variable. Regarding the adhesion to the management guidelines of the DME, a consensus for diagnoses was reached in the registry of metabolic control, type and duration; VA record, anterior and posterior segment examination by biomicroscopy, retinographic image and OCT. For treatment: Initial therapy with central edema without considering VA, the treatment chosen is antivegf, and the first choice was Ranibizumab. If you choose corticosteroids, the first option is dexamethasone. Ranibizumab edema was treated in pirmer instead of argon laser retinopathy. For follow-up VA is performed, anterior and posterior segment examination, retinography and OCT. Fluorescein angiography is rarely required and visits are spaced 1-3 months

Conclusions:

The clinical results by region were homogeneous, and congruent with other clinical practice studies. There is consensus on the most outstanding aspects of diagnosis, treatment and follow-up of EMD. The proposed improvements are aimed at reducing administrative procedures and optimizing patient flows, as well as increasing adherence to patients' treatments

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