Macular edema, swelling of the center of the retina (the part of the eye responsible for our sharpest vision), is an important cause of poor vision in patients with diabetes. New forms of therapy are desirable because the current treatment including laser photocoagulation does not control all cases of diabetic macular edema (DME) and because laser therapy may destroy normal retinal tissue. Intraocular steroids in the form of intravitreal triamcinolone acetate injection (IVTA) and surgical implantation of fluocinolone acetonide (FAI) or dexamethasone drug delivery system (DDS) are promising new therapies. This systematic review included seven randomized clinical trials involving 632 eyes from five countries evaluating the effectiveness and safety of intravitreal steroids for treating DME. Two trials were at low risk of bias, one was at median risk of bias, two were at high risk of bias, and the remaining two had an unclear risk of bias. In this systematic review, the preponderance of data suggest a beneficial effect from IVTA. The average improvement in visual acuity was letters more (- LogMAR; 95% CI - to -) in the IVTA treated eyes than in those treated with other therapies at three months (based on three trials), letters more (- LogMAR; 95% CI - to -) at six months (two trials), letters more (- LogMAR; 95% CI - to -) at nine months (one trial), and letters more (- LogMAR; 95% CI - to -) at 24 months (one trial). Improved clinical outcomes were also reported in FAI and dexamethasone DDS trials. Elevation of intraocular pressure and cataract progression occur in both IVTA and implants treated eyes but appear manageable.
Laser is a very bright light that is very focused so it makes tiny burns on the retina. The burns are so tiny they cause very little damage when treating this type of maculopathy. Once again, controlling your blood pressure, sugar, and fat levels (see Prevention) can help to stop this condition getting worse. Laser for this type of retinopathy is not painful, and is moderately effective (see evidence) . Sometimes the leak needs more than one laser treatment or injection treatment. More often than not more leaks develop over the next few years, again needing laser, as below. See photo , another Content on this page requires a newer version of Adobe Flash Player.
• In a study comparing two treatments for CME
secondary to RVO, researchers found similar
safety and efficacy in patients who had previously
undergone anti-VEGF therapy and switched to
TA or the dexamethasone intravitreal implant.
• Significant changes in cost were observed when patients were switched from anti-VEGF therapy to steroid therapy. The cost significantly decreased in patients switched to TA, whereas it significantly increased in those switched to the dexamethasone intravitreal implant.