Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Ophthalmol. May 12, 2015; 5(2): 55-72
Published online May 12, 2015. doi: 10.5318/wjo.v5.i2.55
State of the art management of diabetic macular edema
Ramin Nourinia, Masoud Soheilian
Ramin Nourinia, Masoud Soheilian, Ophthalmology Department and Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti Universityof Medical Sciences, Tehran 16666, Iran
Masoud Soheilian, Negah Eye Hospital, Tehran 16666, Iran
Author contributions: All the authors contributed to this work.
Conflict-of-interest: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Masoud Soheilian, MD, Professor of Ophthalmology, Ophthalmology Department, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Pasdaran Ave. Boostan 9 St. Tehran 16666, Iran.
Telephone: +98-21-22562138 Fax: +98-21-22562138
Received: February 12, 2014
Peer-review started: February 13, 2014
First decision: March 12, 2014
Revised: January 21, 2015
Accepted: January 30, 2015
Article in press: February 2, 2015
Published online: May 12, 2015

Macular edema following diabetic retinopathy is one of the ocular complications associated with diabetes, and it is the leading cause of visual loss in the active young and middle aged population in developed countries. While all patients with diabetes particularly those with diabetic retinopathy are at increased risk of developing eye complications, early detection and timely intervention may prevent or delay loss of visual acuity. Systemic management of diabetes through combined control of blood sugar, hypertension, and hyperlipidemia has remained the most effective method to prevent diabetic retinopathy and its progression. Development of diabetic retinopathy and related complications require, surgical and medical interventions including photocoagulation, vitrectomy, and intravitral drug injection to preserve vision. Considering recently most popular treatment of diabetic macular edema (DME) including intravitreal anti-vascular endothelial growth factor (VEGF) agents, several issues such as ideal regimen, duration of treatment, combination therapy and long -term safety have remained unanswered yet and deserve further investigations. In this review, all the articles that had investigated such treatment modalities for DME as well as pharmacokinetic, efficacy, safety, dose and frequency of intravitreal pharmacologic agents and also the effect of macular ischemia, initial macular thickness and optical coherence tomographic patterns of DME on the final outcomes of treatment with Intravitreal drugs are reviewed. In summary, literature searches reveal that almost all studies that have been published up to now provide some evidence that support the use of intravitreal anti-VEGF agents for treatment of either naïve or persistent DME in short and long term up to two years.

Keywords: Intravitreal vascular endothelial growth factor inhibitor agent, Clinically significant diabetic macular edema, Diabetic retinopathy, Macular laser photocoagulation, Intravitreal steroid

Core tip: There are multiple treatment approaches for diabetic macular edema so in this article we reviewed almost all treatment modalities for diabetic macular edema and efficacy and side effects of them.