Diabetic Macular Edema: Changing Treatment Paradigms

J. Fernando Arevalo


Curr Opin Ophthalmol. 2014;25(6):502-507. 

In This Article


Within the last 5 years, the use of intravitreal corticosteroids and intravitreal anti-VEGF agents has come into clinical practice for the management of DME, and several recent randomized clinical trials have shown improved effectiveness of ranibizumab compared to focal/grid laser.[8,9,10,11,12]

The cause of DME is multifactorial. Therefore, the study of the important aspects of the pathogenesis and molecular pathways involved in the development of DME has led to the development of improved therapies for DME that have come into use in clinical practice. Additional promising therapeutic agents are currently being evaluated in clinical trials and additional molecular targets are being evaluated.[31] Combined therapies targeting multiple pathways may yield synergistic treatment responses as several cytokines may be involved in the development of DME. The current evidence in the literature for the use of vitrectomy in the treatment of DME with and without taut posterior hyaloid or traction is not comprehensive,[32] and enzymatic vitreolysis could be considered a good therapeutic alternative in diabetic retinopathy and macular edema, and could potentially decrease the number of anti-VEGF injections needed to control DME.[33]