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What have we learnt about the management of diabetic macular edema in the antivascular endothelial growth factor and corticosteroid era?

Agarwal, Aniruddha; Sarwar, Salman; Sepah, Yasir J.; Nguyen, Quan D.

Current Opinion in Ophthalmology: May 2015 - Volume 26 - Issue 3 - p 177–183
doi: 10.1097/ICU.0000000000000152
RETINAL, VITREOUS AND MACULAR DISORDERS: Edited by Brandon G. Busbee and John W. Kitchens

Purpose of review To summarize the outcomes of the use of antivascular endothelial growth factor (anti-VEGF) agents and corticosteroids on the treatment paradigm for diabetic macular edema (DME).

Recent findings Favorable efficacy data along with acceptable long-term safety results of anti-VEGF agents have made them the standard first-line therapy in the management of DME. Level I evidence from large, multicenter clinical trials has established the beneficial role of anti-VEGF agents and intravitreal steroids. In addition, the role of anti-VEGF agents in the treatment of diabetic retinopathy has also been recently recognized. However, concerns such as suboptimal response, VEGF resistance, and long-term effects on retinal layers and vasculature have also been highlighted recently.

Summary The use of anti-VEGF agents and corticosteroids has revolutionized the management of DME. Despite the advantages including ease of administration, low incidence of adverse events, and concomitant improvement in retinopathy status, limitations of this therapeutic approach have been recognized. The current review will focus on the lessons learnt in the management of DME in the anti-VEGF and steroid era.

Ocular Imaging Research and Reading Center (OIRRC), Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA

Correspondence to Quan D. Nguyen, MD, MSc, University of Nebraska Medical Center, 985540 Nebraska Medical Center, Omaha, NE 68198-5540, USA. Tel: +1 402 559 4276; fax: +1 402 559 5514; e-mail:

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