Current trends in the treatment of diabetic macular edema

Abstract

Since the introduction of focal/grid macular laser over 25 years ago and until recently, laser photocoagulation has been the standard of care in the treatment of diabetic macular edema (DME). Whilst laser photocoagulation was shown to halve the risk of moderate visual loss over 3 years, from 24% to 12%, only < 5% of patients achieves better visual acuity. Within the last 5 years, the use of intravitreal corticosteroids and intravitreal anti-vascular endothelial growth factor (VEGF) agents have come into clinical practice for the management of DME and several recent randomized clinical trials have shown superior effectiveness of anti-VEGF treatments compared to conventional macular laser. The introduction of depot steroid injections as flucinolone acetoinde has also lead to a current increase in interest in the use of intravitreal corticosteroids for DME treatment. In this review, we discuss the ocular treatment options currently available for the treatment of DME, mainly focusing on macular laser as well as intravitreal anti-VEGF and corticosteroid treatments.