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Review Article

Evidence-based Management of Diabetic Macular Oedema: Clinical and Public Health Implications

Sambuddha Ghosh, Udit Raj Sharma, Gautam Bhaduri



Diabetic macular oedema (DME) is one of the major causes of vision loss in diabetes patients. Not all cases of diabetic macular oedema require treatment. Laser photocoagulation was the treatment of choice in clinically significant macular oedema since the 1990s. Although laser prevents vision loss, gain in vision is uncommon. This generated need for newer mono or adjunctive therapies for diabetic macular oedema. Better understanding of pathogenesis and availability of improved imaging techniques helped scientists conduct studies and offer alternate/ adjunctive treatment options. Evidence-based treatment options led to a paradigm shift in the management of diabetic macular oedema . Role of various anti-vascular endothelial growth factors agents and corticosteroids with or without laser have been studied. Based on current evidence anti-vascular endothelial growth factors therapy is recommended for patients with centre-involved diabetic macular oedema which can improve vision significantly. However alongside the actual procedure of the injection itself, it needs regular follow-up that adds a huge burden to most healthcare systems. The economic burden, for both patients and the society, is also a major concern. Until we have a longeracting safe treatment for diabetic macular oedema, combination therapy utilising currently available pharmacotherapies with macular laser appears to be a practical and sustainable approach.


Diabetic macular oedema, anti-vascular endothelial growth factors, ranibizumab, bevacizumab, aflibercept, corticosteroids, laser

Journal: Medical Glory Vol 1, Issue No 3, July-September, 2017