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Clinical Practice GuidelinesClinical Practice Guidelines
Open Access

Saudi Arabia Guidelines for diabetic macular edema

A consensus of the Saudi Retina Group

Abdullah S. AlQahtani, Mohammad A. Hazzazi, Saad A. Waheeb, Valmore A. Semidey, Valmore A. Semidey, Hussein K. Elgendy, Wajeeha I. Alkhars, Marwan A. Abouammoh and Hassan Al-Dhibi
Saudi Medical Journal February 2021, 42 (2) 131-145; DOI: https://doi.org/10.15537/smj.2021.2.25623
Abdullah S. AlQahtani
From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
MD, DES
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Mohammad A. Hazzazi
From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
BsC, MD
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Saad A. Waheeb
From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
MD, FRCSC
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Valmore A. Semidey
From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
MD
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Valmore A. Semidey
From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
MD
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Hussein K. Elgendy
From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
MD, FRCS
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Wajeeha I. Alkhars
From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
MD, FRCS
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Marwan A. Abouammoh
From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
MD
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Hassan Al-Dhibi
From the Department of Surgery (AlQahtani), Division of Ophthalmology, National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Ophthalmology (Waheeb), King Fisal Specialist Hospital and Research Center; from the Department of Ophthalmology (Elgendy), Retina Unit, Magrabi Eye and Ear Hospital, Jeddah; from the Department of Surgery (Hazzazi), Division of Ophthalmology, Riyadh National Guard Hospital, and from King Saud bin Abdulaziz University for Health Sciences; from the Department of Vitreoretinal (Semidey, Al-Dhibi), King Khalid Eye Specialist Hospital; from the Department of Ophthalmology (Abouammoh), College of Medicine, King Saud University, Riyadh; and from the Department of Retina and Uveitis (Alkhars), Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia.
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Article Figures & Data

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  • Figure 1
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    Figure 1

    - Treatment algorithm for diabetic macular edema

Tables

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    Table 1

    - Reported cut-off values according to different optical coherence tomography (OCT) machines.

    MachineBentaleb-Machkour et al54Cochrane review55Brown et al56Campbell et al57Goebel et al58
    Stratus OCT197 μm230 μm300 μm240μmNA
    Cirrus HD-OCT254 μm254 μmNANANA
    Spectralis HRA+OCT236 μm300 μmNANANA
    OCT 2000 scannerNANANANA230 μm
    • OCT: optical coherence tomography, HRA: heidelberg retina angiograph

    • View popup
    Table 2

    - Summary of real-life studies supporting the safety and efficacy of anti-VEGFs.

    StudyDrugsStudy designPatient statusNumber (eyes)Follow-up (months)Mean number IVIBaseline VA (letters)Final VA (letters)Mean VA gain (letters)Mean CRT reductionIOPCataract progression/extraction
    Bahrami et al91AfliberceptProspectiveNon-Naïve436567.8713.237 μm0% (IOP ≥25 mmHg or a rise of IOP ≥10 mmHg)0%
    Kaiho et al92AfliberceptNDNon-Naïve51123.865.5704.5NDNDND
    Aksoy et al93BevacizumabProspectiveNaïve20665155.54.5210 μm10% (IOP >21 mmHg)2.50%
    Fong et al94BevacizumabRetrospectiveMixed (65% naive, 30% laser, 4% steroid)309243.15762.35.3NDNDND
    Güler et al95BevacizumabProspectiveND209638424295 ± 42 μmND0%
    Koc et al96BevacizumabRetrospectiveNaïve90244.945.248.73.574.7 ± 133.9ND13.70%
    Riazi-Esfahani et al97BevacizumabNDNaïve466 67.572.55102 ± 1086.5% (IOP ≥21 mmHg)0
    Cheema et al98Bevacizumab (diffuse)RetrospectiveND2861.344451NDNDND
    Ciulla et al99RanibizumabRetrospectiveNon-Naïve331265963444 μmNDND
    Egan et al100RanibizumabRetrospectiveMixed (49.6% Naive)3103245.451.152.51.4NDNDND

    IVI: intravitreal injection, VA: visual acuity, CR: central retnal thickness, IOP: intra-ocular pressure, ND: not determined/detected

      • View popup
      Table 3

      - Summary of real-life studies supporting the safety and efficacy of dexamethasone implants.

      StudyStudy designPatient statusNumber (eyes)Follow-up (months)Mean number IVIMean VA gain (letters)CRT reduction by OCTIOPCataract progression/extraction
      Chatziralli et al110ProspectiveNon-naive54122.15.2181 μm5.6% (IOP >20 mmHg)4.30%
      Cicinelli et al108RetrospectiveNon-naive45121.95.829 μm18.4% (IOP ≥20 mmHg)20%
      Iglicki et al111RetrospectiveNon-naive59243.18.5ND7.10%ND
      Guigou et al112RetrospectiveMixed (20.5% de naive)7861.28.0145.2 μm11.7% (IOP >25 mmHg), 13.3% (rise of IOP >10 mmHg)0%
      Pareja-Rios et al113RetrospectiveNaive113121.49.732 μm4% (rise of IOP >10 mmHg)ND
      Bellocq et al114ProspectiveMixed (73% naive)3761.510.1206 μm14% (IOP > 25 mmHg), 3% (IOP >35 mmHg) 8% (rise of IOP > 10 mmHg)ND
      Malcles et al115RetrospectiveMixed (27% naive)128363.69.5138 μm10.2% (IOP >25 mmHg), 2.3% (IOP >35 mmHg) 19% (rise of IOP >10 mmHg)ND
      Scaramuzzi et al116RetrospectiveMixed (7% naive)15122.08.5240 μm20%8.30%

      IVI: intravitreal injection, VA: visual acuity, CRT: central retnal thickness, IOP: intra-ocular pressure, ND: not determined/detected, OCT: optical coherence tomography

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      Saudi Medical Journal: 42 (2)
      Saudi Medical Journal
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      1 Feb 2021
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      Saudi Arabia Guidelines for diabetic macular edema
      Abdullah S. AlQahtani, Mohammad A. Hazzazi, Saad A. Waheeb, Valmore A. Semidey, Valmore A. Semidey, Hussein K. Elgendy, Wajeeha I. Alkhars, Marwan A. Abouammoh, Hassan Al-Dhibi
      Saudi Medical Journal Feb 2021, 42 (2) 131-145; DOI: 10.15537/smj.2021.2.25623

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      Saudi Arabia Guidelines for diabetic macular edema
      Abdullah S. AlQahtani, Mohammad A. Hazzazi, Saad A. Waheeb, Valmore A. Semidey, Valmore A. Semidey, Hussein K. Elgendy, Wajeeha I. Alkhars, Marwan A. Abouammoh, Hassan Al-Dhibi
      Saudi Medical Journal Feb 2021, 42 (2) 131-145; DOI: 10.15537/smj.2021.2.25623
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