Emerging pharmacotherapies for diabetic macular edema

Abstract

Diabetic macular edema (DME) remains an important cause of visual loss in patients with diabetes mellitus. Although photocoagulation and intensive control of systemic metabolic factors have been reported to achieve improved outcomes in large randomized clinical trials (RCTs), some patients with DME continue to lose vision despite treatment. Pharmacotherapies for DME include locally and systemically administered agents. We review several agents that have been studied for the treatment of DME.

Figure 1

(a) Fundus photograph, left eye, of a patient with persistent diabetic macular edema following focal/grid photocoagulation. (b) Early phase fluorescein angiograph, left eye, demonstrating abnormal hyperfluorescence in the macula. (c) Late phase fluorescein angiograph, left eye, demonstrating profuse leakage consistent with angiographic macular edema. (d) Spectral domain optical coherence tomograph, left eye, demonstrating cystoid macular edema. (e) Following treatment with intravitreal triamcinolone acetonide, 4 mg in 0.1 mL, spectral domain optical coherence tomography demonstrates marked improvement in cystoid macular edema.

Figure 2

(a) Fundus photograph, right eye, of a patient with persistent diabetic macular edema following focal/grid photocoagulation. (b) Spectral domain optical coherence tomograph, right eye, demonstrates cystoid macular edema and subretinal fluid. (c) Following additional focal/grid photocoagulation and treatment with intravitreal bevacizumab, 1.25 mg in 0.1 mL, fundus photography demonstrates marked improvement in diabetic macular edema. (d) Follow-up spectral domain optical coherence tomography demonstrates marked improvement in intraretinal and subretinal fluid.