CURRENT ADVANCES ON PHARMACOLOGICAL MANAGEMENT OF DIABETIC MACULAR EDEMA: INTRAVITREAL INJECTION APPLICATIONS AND SUSTAINED DRUG DELIVERY SYSTEMS

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Diabetic macular edema is the leading cause of vision loss in diabetic patients. Although laser photocoagulation is used for standart therapy for many years, it is unresponsive in a significant group of patient. Nowadays, intravitreal injection of vascular endothelial growth factor inhibitors has been widely used in diabetic macular edema treatment. As a result of the increase in vascular endothelial growth factor in diabetic retinopathy, retinal vascular permeability increases and this leads to destroy of blood-retina barrier and retinal edema. Many vascular endothelial growth factor inhibitors such as bevacizumab, ranibizumab and pegabtanib sodium are studied on the treatment of diabetic macular edema. Pegabtanib sodium is a ribonucleic acid aptamer which binds to the vascular endothelial growth factor A 165 isomer. It binds selectively to the heparine binding area of vascular endothelial growth factor A and inhibits the binding of vascular endothelial growth factor A 165 and greater isomers to the vascular endothelial growth factor receptor. Pegabtanib sodium demonstrates a great selectivity for vascular endothelial growth factor A. Bevacizumab and ranibizumab are humanized anticor which effect on all isomers of vascular endothelial growth factor A. More recently, aflibercept a recombinant fusion protein binds and inhibits to all isoforms of vascular endothelial growth factor A and B aflibercept was presented for usage. It is also known as vascular endothelial growth factor-trap for blocking the whole vascular endothelial growth factor proteins. Bevasiranib is designed for reducing and inactivating vascular endothelial messanger RNA and sirolimus effects by growth factor induced angiogenesis related with combining signals effect of kinase activity are also used recently. In this review, current use of intravitreal injection applications and sustained drug delivery systems in diabetic macular edema is discussed.

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Diabetic Macular Edema , Bevacizumab , Ranibizumab , Aflibercept

Kocatepe Medical Journal

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Kocatepe Medical Journal