From Monotherapy to Combination Strategies: Redefining Treatment Approaches for Multiple-Cause Macular Edema

Macular edema (ME) is a leading cause of visual impairment in various retinal disorders. Current treatment modalities, including anti-vascular endothelial growth factor (anti-VEGF) agents and corticosteroids, often require repeated applications, increasing both medical and economic burdens. ME is driven by chronic inflammation and VEGF overexpression, causing fluid accumulation in the macula. Recent studies have highlighted the role of various cytokines in ME pathogenesis, necessitating a comprehensive approach to treatment. While monotherapies have shown efficacy, they are associated with limitations such as the need for frequent injections and potential side effects. Combination therapies, including anti-VEGF drugs with macular laser photocoagulation, triamcinolone acetonide, or dexamethasone intravitreal implant (Ozurdex), have emerged as promising strategies. This review analyzes the outcomes of various combination approaches in different types of ME, including diabetic macular edema (DME), retinal vein occlusion-associated ME (RVO-ME), and uveitic macular edema (UME). The potential benefits of combining anti-VEGF and anti-inflammatory treatments are discussed, along with the need for personalized treatment regimens. Future research directions are outlined, emphasizing the importance of large-scale, long-term studies to evaluate the sustained efficacy and safety of combination therapies. The integration of advanced imaging techniques, biomarker analysis, and innovative therapeutic approaches is expected to shape the future landscape of ME management, moving towards more targeted and effective combination therapies.