Long-term Therapies for Diabetic Macular Edema

Abstract

Diabetic macular edema (DME) is one of the main causes of visual loss in diabetic patients. Although photocoagulation and intensive control of systemic metabolic factors have achieved improved outcomes, improvement is slow and some patients with DME continue to lose vision despite treatment. Pharmacological treatment options for DME include vascular endothelial growth factor (VEGF) antagonists such as ranibizumab, bevacizumab and pegaptanib and corticosteroids, whose multiple mechanisms of action include reduction of VEGF expression. Intravitreal delivery of these agents has shown efficacy in the treatment of DME but is associated with adverse effects including cataract progression and sustained rises in intraocular pressure. The physical characteristics and potent anti-inflammatory properties of fluocinolone acetonide (FAc) have led to its use in intravitreal implants. A number of intravitreal implants have been evaluated, of which the most effective at providing sustained drug release with an acceptable safety profile is the ILUVIEN® implant. This FAc intravitreal implant provides significant, long-lasting improvements in visual acuity for patients with chronic DME and has a manageable safety profile.