Guidelines from an expert panel for the management of diabetic macular edema in the Malaysian population
Authors:   Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor 40170, Malaysia; Department of Ophthalmology, Shah Alam Hospital, Ministry of Health, Selangor 40000, Malaysia, Ngah Nor Fariza , Mohamed Shelina Oli ,   Department of Ophthalmology, Shah Alam Hospital, Ministry of Health, Selangor 40000, Malaysia, Aziz Roslin Azni Abdul ,   Department of Ophthalmology, Shah Alam Hospital, Ministry of Health, Selangor 40000, Malaysia, Ma’amor Nur Hasnah ,   Sector for Evidence-based Healthcare, National Institutes of Health, Ministry of Health, Selangor 40170, Malaysia, Tarmidzi Nor Azita Ahmad ,   Department of Ophthalmology, Kuala Lumpur Hospital, Ministry of Health, Federal Territory 50586, Malaysia, Hashim Hanizasurana ,   Department of Ophthalmology, Selayang Hospital, Ministry of Health, Selangor 61800, Malaysia, Ishak Hamisah ,   Department of Ophthalmology, Kuala Lumpur Hospital, Ministry of Health, Federal Territory 50586, Malaysia, Muda Wan Norliza Wan ,   Department of Ophthalmology, Tengku Ampuan Afzan Hospital, Ministry of Health, Pahang 25100, Malaysia, Muda Rosiah ,   Department of Ophthalmology, Sultanah Nur Zahirah Hospital, Ministry of Health, Kuala Terengganu 20400, Malaysia, Adnan Azian ,   KPJ Selangor Specialist Hospital, Selangor 40300, Malaysia, Saleh Rafidah Md ,   Sultan Abdul Aziz Shah Hospital, Selangor 43400, Malaysia, Seng Wong Hon ,   Gleneagles Kuala Lumpur, Federal Territory 50450, Malaysia, Jamil Nurfahzura Mohd ,   Department of Ophthalmology, Sungai Buloh Hospital, Ministry of Health, Selangor 47000, Malaysia, George Tara Mary ,   Sunway Medical Centre, Selangor 47500, Malaysia, Koh Adrian ,   Camden Medical Centre, Singapore 248649, Singapore
Published: April 2023

AIM: To derive a Malaysia guideline and consensus as part of the Malaysia Retina Group’s efforts for diagnosis, treatment, and best practices of diabetic macular edema (DME). The experts’ panel suggests that the treatment algorithm to be divided into groups according to involvement the central macula. The purpose of DME therapy is to improve edema and achieve the best visual results with the least amount of treatment load.
METHODS: On two different occasions, a panel of 14 retinal specialists from Malaysia, together with an external expert, responded to a questionnaire on management of DME. A consensus was sought by voting after compiling, analyzing and discussion on first-phase replies on the round table discussion. A recommendation was deemed to have attained consensus when 12 out of the 14 panellists (85%) agreed with it.
RESULTS: The terms target response, adequate response, nonresponse, and inadequate response were developed when the DME patients’ treatment responses were first characterized. The panelists reached agreement on a number of DME treatment-related issues, including the need to classify patients prior to treatment, first-line treatment options, the right time to switch between treatment modalities, and side effects associated with steroids. From this agreement, recommendations were derived and a treatment algorithm was created.
CONCLUSION: A detail and comprehensive treatment algorithm by Malaysia Retina Group for the Malaysian population provides guidance for treatment allocation of patients with DME.