Management practices for diabetic macular edema (DME) at one comprehensive eye unit in Kenya.

Abstract

Introduction: Diabetic macular edema (DME) is a leading cause of vision impairment among diabetic patients. Traditional grid laser treatment is no longer considered the gold standard treatment, with anti-VEGF therapy emerging as the preferred approach. The objective of this study is to evaluate the management practices for diabetic macular edema (DME) by consultants ophthalmologists at Kikuyu Eye Unit, particularly in the context of the paradigm shift introduced by anti- vascular endothelial growth factor (anti-VEGF) therapy, and to assess the associated visual acuity outcomes.

Materials and Methods: A retrospective hospital-based case study was conducted over six months (October to March 2018). Data were extracted from theatre lists and laser room registration books. Patient files and records were reviewed to gather information on individuals treated with intravitreal injections or laser for DME during this period. All patients treated for DME within the study period were included.

Results:  The study population had a mean age of 50 years or older in 95.9% of patients. Treatment distribution was as follows: 146 eyes (61.3%) received anti-VEGF monotherapy, 6 eyes (2.5%) received triamcinolone alone, 50 eyes (21.0%) underwent central laser treatment, and 36 eyes (15.1%) received combination therapies. Notably, 93 eyes (39.1%) received three or more anti-VEGF intravitreal injections. Post-treatment, 58% of eyes demonstrated a satisfactory visual acuity outcome, defined as a gain of ≥5 ETDRS letters. However, follow-up adherence was suboptimal, and a limited number of patients underwent blood glucose monitoring and optical coherence tomography (OCT) evaluations.

Conclusion: The management of DME at KEU aligns with current treatment guidelines, with anti-VEGF therapy being the most common approach. Visual acuity outcomes were satisfactory for 58% of eyes tested post-treatment. However, there is a need for improved patient follow-up and complementary investigations to enhance treatment outcomes. DME remains a significant challenge for ophthalmologists.