Effect of Therapy on Diabetic Macular Oedema

Abstract

Anti-vascular endothelial growth factor (VEGF) therapies have changed the dynamics in the management of patients with diabetic macular oedema (DME); increasingly it is the treatment of choice when there is extensive oedema in foveal-involving DME. The role of laser in the anti-VEGF era has to be re-examined. Despite the efficacy of laser, the mechanism of laser treatment remains unclear. Armed with extensive clinical trial data and the experience of using anti-VEGF agents for DME, retinal specialists have found that a significant number of patients do not respond to anti-VEGF agents or require continuous monthly dosing. In these patients, steroids may be useful as an alternative or as adjunct therapy. Less than 10 years ago, we only had to decide whether to laser or not. At the time of writing in late 2015, we have three anti-VEGF agents in common use, two approved steroids, and several different new laser modalities as well as our old friend conventional laser. We should also not forget that vitrectomy may be useful in some cases, and pharmaceutical agent to release vitreomacular adhesion may be worth consideration in a few cases.