Steroids agents in the management of vitrectomized eyes with diabetic macular edema

Abstract

SummarySteroid treatments for diabetic macular edema (DME) include intravitreal Triamcinolone Acetonide (IVTA) or subtenon Triamcinolone Acetonide (STTA), the Dexamethasone 0.7 mg implant (Ozurdex, Allergan) and the Fluocinolone 190 µg implant (Iluvien, Alimera). Most IVTA studies in vitrectomized eyes have too many confounders including additional treatments such as macular laser or anti‐VEG injections, variable outcome measures and follow up times. Furthermore, IVTA was usually given either at the time of pars plana vitrectomy (PPV) to better visualize the vitreous, or at the end of PPV and sometimes combined with an anti‐VEGF. STTA data are based on small non‐randomized studies with short‐term follow up. Whilst some studies have shown limited benefit, studies that compared vitrectomized and non‐vitrectomized eyes found no difference in VA. Current data based on the Ozurdex implant in vitrectomised eyes found short‐term benefit for both visual acuity (VA) and macular thickness. No data is available at the present time for the use of the Iluvien implant for DME in previously vitrectomized eyes. Randomized controlled data are lacking to evaluate the role of steroids for the management of DME in the vitrectomized eye.