Long-Term Outcome of Approved Pharmacotherapy for Diabetic Macular Edema: A Review of Randomized Controlled Trials in Fluocinolone Acetonide Implants, Dexamethasone Implants, Aflibercept and Ranibizumab

Abstract

Diabetic macular edema (DME) is a major sight-threatening cause in diabetic patients. The pathophysiology of macular edema involves both the presence of inflammation and angiogenic stimulant regarding vascular endothelial growth factor (VEGF) [1]. Intravitreal injections of anti-VEGF, including ranibizumab [2-8], bevacizuamb [9], pegaptanib [10], aflibercept [11] are proven to be effective for managing DME. Intravitreal injections of corticosteroids, potent anti-inflammatory agents, such as fluocinolone acetonide implants (Retisert) [12], fluocinolone acetonide inserts (Iluvein) [13,14], dexamethasone implants [15,16], and triamcinolone acetonide [2] have been shown to be beneficial to DME. The Food and Drug Administration of US and European Medicines Agency have approved intravitreal injections of fluocinolone acetonide inserts (Iluvein), dexamethasone implants, aflibercept, and ranibizumab for treating DME. Herein the long-term outcome of the randomized controlled studies in these approved pharmacotherapies will be reviewed.