Update on treatments for diabetic macular edema.
OBJECTIVE
Due to modest outcomes with macular laser, other treatment modalities for diabetic macular edema have been evaluated. Intravitreal triamcinolone acetonide, pars plana vitrectomy, oral protein kinase C inhibitors and, from more recently, anti-vascular endothelial growth factor therapy are reviewed.


RESULTS
Intravitreal triamcinolone acetonide may be more effective than laser. Intravitreal triamcinolone acetonide followed by laser may be more effective than intravitreal triamcinolone acetonide alone. Ruboxistaurin, a selective protein kinase C betainhibitor, reduced retinal vascular leakage in patients with diabetic macular edema and reduced the rate of sustained moderate visual loss in those with moderately severe to very severe non proliferative diabetic retinopathy. Several anti-vascular endothelial growth factor agents are under evaluation. Intravitreal pegaptanib sodium (0.3 mg) improved vision and reduced central retinal thickness compared to sham. Data on the other anti-vascular endothelial growth factor agents is limited, but there are promising results, with ranibizumab (0.5 mg) and bevacizumab reducing foveal thickness and improving visual acuity in some patients with diabetic macular edema.


CONCLUSIONS
There remains no proven intervention that consistently prevents or reverses visual loss from diabetic macular edema in all patients. A variety of promising new medical and surgical therapies are under investigation, but further research is required to determine their role alone or in combination.
Fraser-Bell
Samantha
S
Medical Retinal Service, Moorfields Hospital, London, UK bDepartment of Ophthalmology, University of Sydney, NSW, Australia.
Kaines
Andrew
A
Hykin
Phillip G
PG
D048909:Diabetes Complications / Q000150:complications / Q000628:therapy*; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005446:Fluocinolone Acetonide / Q000008:administration & dosage; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D007267:Injections; D017075:Laser Coagulation / Q000379:methods*; D008269:Macular Edema / Q000209:etiology / Q000628:therapy*; D008301:Maleimides / Q000627:therapeutic use; D011493:Protein Kinase C / Q000037:antagonists & inhibitors; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage; D014821:Vitrectomy / Q000379:methods*; D014822:Vitreous Body
D004791:Enzyme Inhibitors; D005938:Glucocorticoids; D007211:Indoles; D008301:Maleimides; D005446:Fluocinolone Acetonide; C099154:ruboxistaurin; D011493:Protein Kinase C; D014222:Triamcinolone Acetonide