Diabetic Macular Edema and Steroid Management

Although laser treatment for diabetic macular edema (DME) may reduce the risk of vision loss by 50%, it is not effective in all cases. In 10% to 12% of cases, DME does not respond to laser treatment. Patients with diffuse DME, in particular, are more likely to experience poor outcomes. When laser treatment is not effective, intravitreal steroid therapy is another therapeutic option. Steroids provide a number of benefits, including stabilization of the blood-retinal barrier, down regulation of vascular endothelial growth factor (VEGF), and anti-inflammatory properties. Treatment with intravitreal steroid injection has been associated with both anatomical and functional improvement in the short term, and it has been readily accepted by the ophthalmologic community. This strategy, however, often requires retreatment, and the optimal dose is not known. Furthermore, a number of complications can occur, including cataract, glaucoma, and endophthalmitis.