Diabetic macular edema: New promising therapies

Abstract

The treatment of diabetic macular edema is rapidly evolving. The era of laser therapy is being quickly replaced by an era of pharmacotherapy. Several pharmacotherapies have been recently developed for the treatment of retinal vascular diseases such as diabetic macular edema. Several intravitreal injections or sustained delivery devices have undergone phase 3 testing while others are currently being evaluated. The results of clinical trials have shown the superiority of some of these agents to laser therapy. However, with the availability of several of these newer agents, it may be difficult to individualize treatment options especially those patients respond differently to various therapies. As such, more effort is still needed in order to determine the best treatment regimen for a given patient. In this article, we briefly summarize the major new therapeutic additions for the treatment of diabetic macular edema and allude to some future promising therapies.

Keywords: Diabetic macular edema; Diabetic retinopathy; Intravitreal injection; Laser photocoagulation; Pharmacotherapy; Sustained release drug delivery devices; Vitrectomy.

Figures

Figure 1

Horizontal spectral-domain optical coherence tomography scans of the macula before (A) and after (B) 1 mg of intravitreal triamcinolone therapy in a patient with diabetic macular edema in the right eye. Four months following treatment, the macular edema almost completely resolved (B). The Snellen visual acuity improved from 20/200 to 20/60.

Figure 2

Horizontal spectral-domain optical coherence tomography scans of the macula before (A and B) and after (C and D) intravitreal bevacizumab therapy in a patient with diabetic macular edema. Note extensive cystoid macular edema in both eyes (A and B) and subretinal fluid in the right (A). Six months following treatment with 3 injections of bevacizumab, the macular edema almost completely resolved in both eyes (C and D). The Snellen visual acuity improved from 20/125 to 20/70 in the right eye, but did not change significantly in the left, likely due to atrophic changes in the outer retina as seen on optical coherence tomography.

Figure 3

Spectral-domain optical coherence tomography scans of the macula before (A) and after (B) pars plana vitrectomy in a patient with diabetic macular edema in the left eye. Note the focal vitreomacular adhesion with associated cystoid macular edema and intraretinal hard exudates. Seven months following surgery, the macular edema completely resolved (B), but the Snellen visual acuity was not changed and measured 20/400 likely due to atrophic changes in the outer retina as seen on optical coherence tomography.