Recent Advances in The Management of Diabetic Macular Edema
Recent Advances in Diabetic Macular Edema Management
Keywords:
Anti-VEGF, Corticosteroid implant, Diabetic macular oedema, Diabetic retinopathy, Optical coherence tomography, Port-delivery system, Ranibizumab
Abstract
Diabetic macular oedema (DME) is a vision-threatening complication of diabetic retinopathy caused by breakdown of the retinal vascular barrier and accumulation of intraretinal or subretinal fluid. Optical coherence tomography (OCT) has transformed diagnosis and treatment monitoring. Intravitreal anti–vascular endothelial growth factor (anti-VEGF) therapy remains the principal treatment for centre-involving DME, but repeated injections create a substantial burden for patients and health-care systems. Recent developments aim to improve durability without compromising vision. Faricimab, a bispecific antibody targeting VEGF-A and angiopoietin-2, permits personalised dosing intervals of up to 16 weeks in appropriately responding eyes. The ranibizumab port-delivery system (PDS) provides continuous drug delivery with refill exchanges every 24 weeks and was noninferior to monthly ranibizumab in the PAGODA randomised trial. Corticosteroid implants remain useful in selected eyes, particularly when anti-VEGF response is inadequate, although cataract formation and intraocular-pressure elevation require careful monitoring. This review summarises current evidence, practical treatment considerations, limitations, and future directions in sustained drug delivery for DME.
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References
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22. Wong TY, Haskova Z, Asik K, Baumal CR, Csaky KG, Eter N, et al. Faricimab treat-and-extend for diabetic macular edema: two-year results from the randomized phase 3 YOSEMITE and RHINE trials. Ophthalmology. 2024;131(6):708-23. doi:10.1016/j.ophtha.2023.12.026.
23. International Council of Ophthalmology. ICO guidelines for diabetic eye care. San Francisco (CA): International Council of Ophthalmology; 2017.
2. Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis (Lond). 2015;2:17.
3. Yau JWY, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556-64.
4. Eter N, Singh RP, Abreu F, Asik K, Haskova Z, Wong TY, et al. YOSEMITE and RHINE: phase 3 randomized clinical trials of faricimab for diabetic macular edema: study design and rationale. Ophthalmol Sci. 2022;2(1):100111.
5. Genentech, Inc. Vabysmo (faricimab-svoa) injection, for intravitreal use: prescribing information. South San Francisco (CA): Genentech, Inc.; 2026. Revised April 2026.
6. Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet. 2010;376(9735):124-36.
7. Zhou J, Song S, Zhang Y, Jin K, Ye J, et al. OCT-based biomarkers are associated with systemic inflammation in patients with treatment-naïve diabetic macular edema. Ophthalmol Ther. 2022;11(6):2153-67.
8. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study report number 1. Arch Ophthalmol. 1985;103(12):1796-806.
9. Abu El-Asrar AM, Morse PH. Laser photocoagulation control of diabetic macular oedema without fluorescein angiography. Br J Ophthalmol. 1991;75(2):97-9.
10. Khanani AM, Campochiaro PA, Graff JM, et al. Continuous ranibizumab via port delivery system vs monthly ranibizumab for treatment of diabetic macular edema: the PAGODA randomized clinical trial. JAMA Ophthalmol. 2025;143(4):326-35.
11. Wells JA, Glassman AR, Ayala AR, Jampol LM, Aiello LP, Antoszyk AN, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med. 2015;372(13):1193-203.
12. Bressler NM, Beaulieu WT, Glassman AR, Blinder KJ, Bressler SB, Jampol LM, et al. Persistent macular thickening following intravitreous aflibercept, bevacizumab, or ranibizumab for central-involved diabetic macular edema with vision impairment: a secondary analysis of a randomized clinical trial. JAMA Ophthalmol. 2018;136(3):257-69.
13. Heier JS, Korobelnik JF, Brown DM, Schmidt-Erfurth U, Do DV, Midena E, et al. Intravitreal aflibercept for diabetic macular edema: 148-week results from the VISTA and VIVID studies. Ophthalmology. 2016;123(11):2376-85.
14. Lin KY, Hsih WH, Lin YB, Wen CY, Chang TJ. Update in the epidemiology, risk factors, screening, and treatment of diabetic retinopathy. J Diabetes Investig. 2021;12(8):1322-35.
15. Wong TY, Sun J, Kawasaki R, Ruamviboonsuk P, Gupta N, Lansingh VC, et al. Guidelines on diabetic eye care: the International Council of Ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings. Ophthalmology. 2018;125(10):1608-22.
16. Salvetat ML, Pellegrini F, Spadea L, Salati C, Musa M, Gagliano C, et al. The treatment of diabetic retinal edema with intravitreal steroids: how and when. J Clin Med. 2024;13(5):1327.
17. Gao L, Tao Y, Zhu J, et al. Intravitreal corticosteroids for diabetic macular edema: a network meta-analysis of randomized controlled trials. BMC Ophthalmol. 2021;21:344.
18. Grover D, Li TJ, Chong CCW. Intravitreal steroids for macular edema in diabetes. Cochrane Database Syst Rev. 2008;(1):CD005656. doi:10.1002/14651858.CD005656.pub2.
19. Boyer DS, Yoon YH, Belfort R Jr, Bandello F, Maturi RK, Augustin AJ, et al. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology. 2014;121(10):1904-14. doi:10.1016/j.ophtha.2014.04.024.
20. Pearson PA, Comstock TL, Ip M, Callanan D, Morse LS, Ashton P, et al. Fluocinolone acetonide intravitreal implant for diabetic macular edema: a 3-year multicenter, randomized, controlled clinical trial. Ophthalmology. 2011;118(8):1580-7. doi:10.1016/j.ophtha.2011.02.048.
21. Wykoff CC, Abreu F, Adamis AP, Basu K, Eichenbaum DA, Haskova Z, et al. Efficacy, durability, and safety of intravitreal faricimab with extended dosing up to every 16 weeks in patients with diabetic macular oedema (YOSEMITE and RHINE): two randomised, double-masked, phase 3 trials. Lancet. 2022;399(10326):741-55. doi:10.1016/S0140-6736(22)00018-6.
22. Wong TY, Haskova Z, Asik K, Baumal CR, Csaky KG, Eter N, et al. Faricimab treat-and-extend for diabetic macular edema: two-year results from the randomized phase 3 YOSEMITE and RHINE trials. Ophthalmology. 2024;131(6):708-23. doi:10.1016/j.ophtha.2023.12.026.
23. International Council of Ophthalmology. ICO guidelines for diabetic eye care. San Francisco (CA): International Council of Ophthalmology; 2017.
Published
2026-09-30
How to Cite
Dhanisha JL, Anandan, H., Akshaya, Preethi Anie E, Bharath Kumar S, Sahare, H., Jenesha Blessie K, & Michael, J. M. (2026). Recent Advances in The Management of Diabetic Macular Edema. Asian Journal of Medical Research, 15(3), 17-19. Retrieved from https://aijournals.com/index.php/ajmr/article/view/2734
Section
Review Article
