The current role of steroids in diabetic macular edema

ABSTRACT

Introduction: Given the role of inflammation in the pathogenesis of diabetic macular edema (DME), the use of intravitreal corticosteroid agents can be a valid therapeutic alternative in the management of DME.

Areas covered: A PubMed-based search was carried out using the terms “Diabetic macular edema’, ‘diabetic maculopathy’, ‘Dexamethasone’, ‘Fluocinolone acetonide’, and ‘Triamcinolone acetonide’. All studies published in English up to October 2019, irrespective of their publication status, were included in this review. Data from international expert meetings and consensuses were also considered in the dissertation.

Expert opinion: Intravitreal devices releasing corticosteroids are safe, effective, and well-tolerated. Steroids should be considered in patients with unsatisfactory response to a first-line trial of anti–vascular endothelial growth factor (VEGF) therapy. Early switch is recommended to avoid irreversible retinal damage due to long-standing DME. Patients should be monitored for cataract worsening or intraocular pressure rise.

KEYWORDS:

• Anti-vascular endothelial growth factor
• corticosteroids
• diabetic macular edema
• diabetic retinopathy
• dexamethasone intravitreal implant
• fluocinolone acetonide intravitreal implant
• triamcinolone acetonide

Article highlights

• Diabetic macular edema (DME) is a leading cause of visual loss in diabetic patients, and intravitreal (IV) anti-VEGF therapy is currently recommended as first-line therapy in most patients.

• Two IV sustained-release corticosteroid devices, known as drug-delivery systems (DDS), are currently approved for DME treatment: dexamethasone implant and fluocinolone acetonide implant.

• Cataract progression and intraocular pressure increase are the most common adverse events associated with IV corticosteroid use; the incidence of the side effects differs between agents.

• A switch to corticosteroids is recommended in patients with sub-optimal response to first-line anti-VEGF therapy.

• Steroids are a valid first-line therapeutic alternative for pseudophakic or vitrectomized patients and for those who are at low risk for glaucoma or at high risk for cardiovascular events.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data Availability Statement

Data sharing is not applicable to this article as no new data were created or analysed in this study.

Additional information

Funding

The authors have no proprietary, funding, or conflicts of interest to disclose.