• Users Online: 91
  • Print this page
  • Email this page
Year : 2019  |  Volume : 9  |  Issue : 4  |  Page : 233-242

Corticosteroids for diabetic macular edema

1 Ophthalmology Department, Mexico Hospital, Costa Rican Social Security, San Jose, Costa Rica
2 College of Enginnering, Cornell University, Ithaca, NY, USA; Macula, Vitreous and Retina Associates of Costa Rica, San Jose, Costa Rica
3 Macula, Vitreous and Retina Associates of Costa Rica, San Jose, Costa Rica
4 Macula, Vitreous and Retina Associates of Costa Rica, San Jose, Costa Rica; Illinois Eye and Ear Infirmary, University of Illinois, Chicago, IL, USA

Correspondence Address:
Dr. Lihteh Wu
Macula, Vitreous and Retina Associates of Costa Rica, San José; First Floor, Mercedes, Tower, Paseo Colon, San Jose

Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjo.tjo_68_19

Rights and Permissions

Diabetic macular edema (DME) is a chronic condition with a multifactorial pathogenesis. Vascular endothelial growth factor (VEGF) and several inflammatory mediators are upregulated in eyes with DME. VEGF inhibitors and corticosteroids have all been used successfully in the management of DME. Currently available corticosteroids include triamcinolone acetonide (TA), the dexamethasone (DEX) intravitreal implant, and the fluocinolone acetonide (FA) intravitreal implant. The response to treatment can vary substantially with each treatment modality. Some cases of DME are VEGF driven, and in others, inflammation plays a key role. Chronicity appears to favor corticosteroid treatment. There are no clear guidelines to guide switching from an anti-VEGF to a corticosteroid. Combination therapy of an anti-VEGF drug and a corticosteroid does not appear to provide additional benefit over monotherapy with either drug. The main advantage of corticosteroids over VEGF inhibitors is their longer duration of action. Vitrectomy does not affect the pharmacokinetics of the corticosteroid implants. Common adverse events of corticosteroids include cataract formation, cataract progression, and ocular hypertension. TA may cause a sterile endophthalmitis and pseudoendophthalmitis. Migration of the intravitreal DEX and FA implants into the anterior chamber can be problematic. Because of their less favorable safety profile, corticosteroids are generally used as a second-line treatment for DME. Advantages of using an intravitreal corticosteroid implant include the reduction of treatment burden and predictable pharmacokinetics even in vitrectomized eyes. Pseudophakic eyes, previously vitrectomized eyes and eyes with long-standing DME, particularly of patients who have difficulty in maintaining a monthly appointment, may benefit from primary treatment with a corticosteroid intravitreal implant.

Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded1178    
    Comments [Add]    
    Cited by others 25    

Recommend this journal