Fast Five Quiz: Diabetic Macular Edema

Andrew A. Dahl, MD


October 20, 2020

Laser photocoagulation is a well-proven therapy to reduce the risk for vision loss from DME. In 1985, the Early Treatment Diabetic Retinopathy Study demonstrated that focal/grid macular laser photocoagulation, targeting microaneurysms and areas of retinal thickening as well as areas of ischemia, could stabilize the progression of DME and decrease the rate of visual loss, and it even improved vision in some patients.

Vascular endothelial growth factor (VEGF) is upregulated in diabetic retinopathy. It increases retinal vascular permeability causing disruption of the blood-retina barrier and resulting in retinal edema. The Diabetic Retinopathy Clinical Research Network (DRCR) has conducted many subsequent randomized clinical trials on the treatment of DME. One of these studies showed that anti-VEGF intravitreal injections are highly effective for treatment of DME.

Although intravitreal steroids are not indicated first-line therapy for most eyes with DME and has been shown to be less effective than laser, there is a role for intravitreal steroids in patients who are incomplete responders to anti-VEGF therapy.

Relieving significant vitreous traction, when present, by vitrectomy may improve DME. In the DRCR Vitrectomy for DME study, central retinal thickness was reduced in over 90% of patients. Although there was central retinal thickness reduction in more than 90% of patients, there was no significant improvement of vision in these patients, whose eyes all had long-standing severe disease and had received numerous rounds of prior treatment. Multiple published series of vitrectomy performed earlier in the course of DME have shown that this surgery can improve visual acuity.

Learn more about treatment and management of DME.


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