Role of intraocular steroids for the treatment of diabetic macular edema

Diabetic macular edema (DME) is a common and treatable cause of moderate vision loss. Since the introduction of focal/grid photocoagulation more than two decades ago, clinicians have been searching for alternative means to prevent further vision loss or improve the vision in eyes with DME, yet laser photocoagulation remains the standard of care. The most widely employed alternative treatment for DME has been the use of intravitreal corticosteroids. Although steroids can reduce the retinal thickening associated with DME, they are associated with adverse side effects such as elevated intraocular pressure and progression of cataract. Recently, a Phase III randomized clinical trial has shown that laser photocoagulation is superior to monotherapy with a preservative-free intravitreal steroid for the treatment of DME for 24 months. Depot steroid preparations, as well as combination therapy of steroid plus laser photocoagulation, are currently being investigated for the treatment of DME.