Nearly, half of the specialists (45.2 %) think that the main biochemical factor involved in DME development is the vascular permeability-potentiating action of
VEGF-A. Most specialists (70.6 %) use three modalities for detecting DME: optical coherence tomography,
fluorescein angiography, and fundus examination. For focal
macular edema, focal
laser is used as first-line
therapy by 70.3 % of specialists, whereas 21.6 % use medical treatment in combination with focal/grid
laser. For diffuse
macular edema, anti-
VEGF therapy is the first choice (72.5 %), irrespective of visual acuity, whereas 17.5 % select off-label sub-Tenon's
steroid injections.
Vitrectomy is often performed for vitreomacular
traction (86.5 %) or when anti-
VEGF agent/
laser therapy is ineffective (73.2 %). For persistent DME after
vitrectomy, anti-
VEGF agents (46.3 %) or
steroids (
intravitreal injections, 14.6 %; sub-Tenon's
injections, 36.6 %) are selected. When applying anti-
VEGF treatment regimen, most specialists continue loading
injections until central
retinal thickness stabilized (51.4 %) or both visual acuity and central
retinal thickness stabilized (24.3 %). In the maintenance phase, many specialists provide
injections with pro re
nata (76.3 %), whereas 50.0 % responded that the treat-and-extend regimen is ideal.
CONCLUSIONS: Our survey presents the current views about the DME management and practice patterns of anti-
VEGF therapy by one part of the
retinal specialists in Japan, and highlights the differences or gaps between evidence and actual clinical practice.