Management of diabetic macular edema

Abstract

Diabetic macular edema (DME) is the main cause of visual impairment in patients with diabetes mellitus (DM). For many years macular laser photocoagulation has been the golf standard therapy for preventing severe visual loss in patients with DME. However, intravitreal pharmacological therapies have changed how DME is managed, improving visual function with a well-documented tolerable safety profile, and providing patients with significant visual acuity gains that are sustainable with repeat injections. Thus, it has been proposed the use of anti-VEGF or corticosteroids agents as the first line of treatment instead of laser therapy in patients with center-involving DME with moderate visual impairment. Patients who do not yet meet the treatment threshold should be managed with laser therapy according to ETDRS guidelines. On the other hand, although further researches are necessary to establish the best way to care DME patients, and given its multifactorial nature, combination therapy of anti-VEGF drugs with corticosteroids is an evolving field in an effort to alleviate the treatment burden of monthly dosing and to assess the efficacy in those individuals with persistent DME despite repeated anti-VEGF injections.