Clinical trials on corticosteroids for diabetic macular edema

Abstract

Diabetic macular edema (DME) is a common cause of visual impairment in diabetic patients. It is caused by an increase in the permeability of the perifoveal capillaries and a disruption of the blood retinal-barrier. The pathogenesis of DME is multifactorial. Several therapeutic modalities have been proposed for the treatment of DME. Corticosteroid treatments have emerged as an alternative therapy for persistent DME or refractory to conventional laser photocoagulation and other modalities, due to anti-inflammatory, anti-vascular endothelial growth factor and anti-proliferative effects. Many studies have demonstrated the beneficial therapeutic effect of corticosteroids with improvement to both retinal thickness and visual acuity in short-term on the treatment of DME. Peribulbar and intravitreal injections have been used to deliver steroids for DME with frequent injections due to the chronic and recurrent nature of the disease. Steroid-related side effects include elevated intraocular pressure, cataract, and injection related complications such as endophthalmitis, vitreous hemorrhage, and retinal detachment particularly with intravitreal steroid injections. In order to reduce the risks, complications and frequent dosing of intravitreal steroids, intravitreal implants have been developed recently to provide sustained release of corticosteroids and reduce repeated intravitreal injections for the management of DME.© 2013 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Corticosteroids; Diabetic macular edema; Intravitreal triamcinolone acetonide injection; Intravitreal steroid sustained-release implants; Peribulbar steroid injections; Subtenon's steroid Injections Core tip: Despite the documented ocular side effects of corticosteroids by the time being they are still considered as one of the essential effective adjunct modalities for the treatment of diabetic macular edema especially in refractory and persistent cases.

Dexamethasone Implants in Patients with Naïve or Refractory Diffuse Diabetic Macular Edema

“…Thus, the gold standard treatment for DME is no longer laser photocoagulation [5,6] but new therapies targeting the inflammatory components of DME, including intravitreal anti-VEGF agents [7,8] and corticosteroids [4]. …”

Sustained-release fluocinolone acetonide intravitreal insert for macular edema: clinical pharmacology and safety evaluation

“…Despite the concerns of cataract and glaucoma with corticosteroid therapies, these agents have been extensively used in ophthalmological practice through systemic, topical, periocular and intravitreal routes [38,39]. With increasing focus on improved visual outcome in patients with ME, there has been a change in the pattern of drug delivery designing.…”

Intravitreal Triamcinolone Acetonide in the Treatment of Ophthalmic Inflammatory Diseases with Macular Edema: A Meta-Analysis Study

“…10 Intravitreal injections of triamcinolone acetonide (TA) have become increasingly popular for treating a broad spectrum of retinal diseases, 11 such as diffuse DME, 12,13 exudative age-related macular degeneration, [14][15][16] uveitis, 17 and macular edema from central retinal vein occlusion. 18,19 Some recent placebo-controlled trials conducted in patients with DME have indicated that intravitreal injections of TA are effective in improving visual acuity (VA) and reducing central macular thickness (CMT), both in early [20][21][22] and late follow-up visits.…”