title: Emerging drugs for diabetic macular edema.
abstract: BACKGROUND
  Diabetic macular edema (DME) is the most common cause of visual impairment due to diabetic retinopathy. The treatment of DME has recently undergone a paradigm shift. Traditionally, photocoagulation was standard treatment, but pharmacologic therapies are becoming increasingly used for this purpose. All currently available drug therapies for DME are either anti-VEGF agents or corticosteroids.
  
  
  METHODS
  The pathogenesis of DME involves angiogenesis, inflammation and oxidative stress. The scientific rationale to treat DME through the pharmacologic blockade of VEGF and other pro-angiogenic factors is discussed. The fluocinolone insert is approved for the treatment of DME in several European countries, but not in the US at this time. Some medications that are already approved for other retinal diseases, most prominently aflibercept and the dexamethasone delivery system, have recently obtained approval for DME in the US. Other compounds are being studied in earlier-phase clinical trials.
  
  
  CONCLUSIONS
  Pharmacologic treatment of DME will likely become increasingly used, especially for patients with edema involving the fovea. At this time, the two main classes of medication for treatment of DME are anti-VEGF agents and corticosteroids. As we continue to collect clinical trials data, the precise role of individual agents, and the continuing role for photocoagulation, will become more clear.
authors.affiliation: University of Miami Miller School of Medicine, Bascom Palmer Eye Institute , 311 9th Street North, #100, Naples, FL 34102 , USA.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Schwartz
authors.forename: Harry W
authors.initials: HW
authors.lastname: Flynn
authors.forename: Ingrid U
authors.initials: IU
authors.lastname: Scott
mesh_terms: D020533:Angiogenesis Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D000818:Animals; D003930:Diabetic Retinopathy / Q000150:complications / Q000188:drug therapy*; D017277:Drug Approval; D015195:Drug Design; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008269:Macular Edema / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; D005938:Glucocorticoids; D042461:Vascular Endothelial Growth Factor A
keywords: VEGF; aflibercept; bevacizumab; dexamethasone; diabetic macular edema; fluocinolone acetonide; randomized clinical trial; ranibizumab; triamcinolone acetonide