Treatments for Diabetic Macular Edema

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The treatment options for diabetic macular edema include intravitreal injection of anti-VEGF medications, combination anti-VEGF and anti-ANG2 medications, intravitreal injection of corticosteroids, and macular laser procedures.

Anti-VEGF medications are injected into the eye and bind soluble VEGF protein, which then can subsequently reduce the swelling or thickening leading to diabetic macular edema. For anti-VEGF injections, the pros include that this is a safe and effective treatment for majority of patients. One downside of anti-VEGF medications includes repeated injections in the clinic. This increases the treatment burden for patients with diabetic macular edema.

An exciting development in the treatment of diabetic macular edema is the recently FDA-approved treatment Faricimab, which is delivered as an intravitreal injection. It is a novel combined mechanism inhibitor that binds VEGF and a separate growth factor called angiopoietin-2 or ANG2. The anti-ANG2 effect is believed to provide additional stability of blood vessels. Having a new pharmacotherapy that acts in this dual mechanism provides additional options for patients resistant to existing medications. In addition, studies have shown that in some patients, Faricimab can actually extend the time between treatments, thus decreasing the treatment burden over time.

Intravitreal corticosteroids can be injected directly or as a drug-eluting implant into the eye. Corticosteroids can be effective in patients who are resistant to anti-VEGF medications. Intravitreal corticosteroids have the risk of increasing intraocular pressure, which can lead to glaucoma. Macular laser involves the sealing and burning of specific leaking blood vessels. Macular laser procedure has the benefit of not requiring repeated injections of intravitreal medications.

One risk of macular laser procedures includes the creation of blind spots or scotomas. The possible side effects of any intravitreal injection for the treatment of diabetic macular edema include infection, bleeding, cataract formation, intraocular inflammation, retinal tears, and retinal detachments. To determine which treatment modality is most appropriate, retina specialists will take a thorough history and examine the retina closely.

In addition, diagnostic imaging can be used to aid retina specialists in determining the most appropriate treatment modality. Not only is controlling diabetes important, controlling other comorbidities like hypertension or high blood pressure and hyperlipidemia or high cholesterol can offer more hope for patients with diabetic macular edema in restoring vision so that they can return to their activities of daily living and have a much improved quality of life.