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WorksheetsDME: Evidence to real world
Total questions: 16
Worksheet time: 9mins
Please mention your name.
•Scenario 1 a:A 55-year-old gentleman came for a regular check-up. His visual acuity (VA) was 6/6, N6 in both eyes. Fundus showed moderate non-proliferative diabetic retinopathy with cystoid macular edema. OCT scans of both the eyes showed centre-involving DME.
Will treat if VA decreases
Will treat immediately with anti-VEGF
Will treat if edema increases but vision stable
Scenario 1b: The same patient has decided to undergo anti-VEGF injection and he wants to know which anti-VEGF injection to choose. Which anti-VEGF would you suggest?
Bevacizumab or its biosimilar
Ranibizumab or its biosimilar
Aflibercept or its biosimilar
Scenario 2: A 50-year-old woman with severe non proliferative diabetic retinopathy with centre involving diabetic macular edema in right eye presents to you for evaluation. Visual acuity is 6/18, N12 in the right eye and 6/6, N6 in the left eye. OCT of the right eye is shown here. How will you treat?
Loading dose (3 injections) - PRN (monthly visits)
PRN from initiation (monthly visits)
Treat & Extend – 3 monthly injections even if no edema
Treat & Observe – review 3 monthly once stable (from year2)
Treat & Observe – review 3 monthly once stable (even in year 1)
What type of fluid can be tolerated in DME?
>20/30 Vision with some IRF
> 20/30 Vision with some SRF
> 20/30 Vision with some SRF and IRF
What switch is done in recalcitrant edema?
To another anti-VEGF
To steroid
To another anti-VEGF if non-responsive to steroid
Scenario 3: A 60 year old male with NPDR with DME in both eyes and history of intra-vitreal anti VEGF in both eyes has presented to you. Visual acuity in the left eye is 6/60, N 36 and the OCT picture is shown below. How would you treat?
Observe
Intravitreal steroid
Intravitreal steroid +/- anti-VEGF
Systemic lipid lowering agent (in addition)
When should lipid lowering agents be added?
Only in patients with elevated lipid levels
Even in patients with normal lipids (fenofibrate)
Only if associated with hard exudates
Scenario 4: A 55 year old patient presents with findings of treatment naïve proliferative diabetic retinopathy in both eyes with vision of 6/6, N6. OCT of right eye is shown below with non centre involving DME. What is your treatment option in such patients?
PRP alone
PRP + focal laser/ grid
Anti- VEGF followed by PRP to prevent CI - DME
Scenario 5: A 60 year old woman is found to have treatment naïve proliferative diabetic retinopathy changes with diabetic macular edema in both eyes. Her BCVA in the right eye is 6/24, N12 and in the left eye is 6/36, N 18. What is your treatment of choice?
Only anti-VEGF- ability to reverse stage of retinopathy
Anti-VEGF- PRP within 1 month
Anti-VEGF, immediate PRP
What features should prompt steroids as a first choice?
Neurosensory detachment
Hyperreflective dots
Hard exudate clumps
Spongy edema
How is focal laser performed ?
Clinically visible red spots
MA visible on OCTA
MA leaking on FA
Is there a role for grid laser anymore?
I don't do grid laser
Yes, to areas of retinal thickening on OCT
Yes, to areas of diffuse leak on FA
What is the lower threshold for vitrectomy in PDR+DME?
Lower threshold to perform vitrectomy (PHF tangential traction in PDR)
No change in protocol
If DME is associated with HE plaque at fovea
When is ILM peeling done?
No ILM peeling
Fovea sparing ILM peeling- always
Fovea sparing ILM peeling only if risk of deroofing cyst
When is vitrectomy done in non-tractional DME?
Never
In recalcitrant edema
In those with follow up issues
