Diabetic macular edema: changing treatment paradigms

To review the current management and recent changes in treatment paradigm for diabetic macular edema (DME).

During the review period (1 year), several prospective studies analyzed the beneficial effect of anti-vascular endothelial growth factor agents in the management of DME. An exploratory analysis concluded that intravitreal ranibizumab appears to be associated with a reduced risk of diabetic retinopathy worsening. A randomized, controlled, multicenter, double-masked, parallel-group, 12-month trial to evaluate a dexamethasone intravitreal implant (DEX implant) combined with laser photocoagulation compared with laser alone for treatment of DME concluded that there was no significant between-group difference at month 12. A multicenter, prospective, observational study found that in eyes with diabetic retinopathy without concurrent central-involved DME, presence of noncentral-involved DME immediately prior to cataract surgery or history of DME treatment may increase the risk of developing central-involved macular edema after cataract extraction. Another randomized trial to evaluate whether intravitreal ranibizumab injection at cataract surgery prevents postoperative DME concluded that intravitreal ranibizumab injection at cataract surgery may prevent the postoperative worsening of macular edema.

The results of clinical trials have shown the superiority of some of these anti-vascular endothelial growth factor agents to laser therapy. However, with the availability of several of these newer agents, it may be difficult to individualize treatment options, especially if DME patients respond differently to various therapies.