Managing Patients With High-Risk PDR and DME

This is a video synopsis of a discussion involving Ehsan Rahimy, MD, a retina specialist at the Palo Alto Medical Foundation and adjunct faculty at Stanford University School of Medicine. Dr. Rahimy addresses the management of a patient with high-risk proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) who has shown limited response to anti-vascular endothelial growth factor (anti-VEGF) therapy.

He discusses the need for a flexible treatment approach and mentions the possibility of switching to different agents such as aflibercept or faricimab based on the patient's response. Dr. Rahimy emphasizes the importance of close monitoring and quick adjustments in treatment, including the consideration of adding steroid therapy like Ozurdex (dexamethasone implant) for cases exhibiting signs of inflammation on optical coherence tomography (OCT).

Dr. Rahimy highlights the significance of phenotypic markers in determining treatment strategies, suggesting the use of wide-field fluorescein angiography (FA) to assess vascular leakage and guide therapy decisions. He also discusses the potential role of longer-term steroid options like a fluocinolone implant for patients with a good response to initial steroid treatment.

Furthermore, Dr. Rahimy emphasizes the importance of integrating panretinal photocoagulation (PRP) laser therapy for patients with high-risk PDR, particularly those who may be non-compliant with office visits. He stresses the need for patient education regarding the intensive nature of treatment and the potential consequences of non-adherence, especially for patients at risk of significant vision loss.

In summary, Dr. Rahimy provides insights into a comprehensive and dynamic approach to managing complex cases of diabetic retinopathy, highlighting the importance of personalized treatment plans and proactive monitoring to optimize patient outcomes.

Video synopsis is AI-generated and reviewed by HCPLive® editorial staff.