Corticosteroids in the treatment of diabetic macular edema


Authors: Jana Štefaničková;  Silvia Krajčovičová
Authors‘ workplace: Klinika oftalmológie LF UK a UNB, Nemocnica Ružinov, Bratislava
Published in: Forum Diab 2021; 10(2): 121-128
Category:

Overview

Diabetic macular edema is the main cause of decreased vision in diabetic patients in developing countries. Pathogenesis is multifactorial, upregulation of vascular endothelial growing factor, oxidative stress, inflammation and different metabolic pathways lead to breakdown of hematoretinal barrier, loss of pericytes, endothelial cells tight junction disruption and formation of macular edema. For more than 30 years, lasercoagulation has been the gold standard in the treatment of diabetic macular edema. Although antivascular endothelial growing factors are the first – line treatment option in eyes with DME, corticosteroids have the important role as well. The main advantage of corticosteroids is their antiinflammatory, antiapoptotic, antiedematous and antiangiogenic effects. This treatment could be especially effective in pseudophakic patients poorly responsive or refractive to antiVEGF treatment, as well as method of choice in pregnant and lactating women or in patients unwilling to come for numerous monthly injections. Currently available triamcinolone acetonide has been used for many years, but is not approved for this indication yet. Intravitreal-steroid-related side effects are cataract and elevation of intraocular pressure corticosteroids are triamcinolon acetonide, dexamethasone and fluocinolone acetonide intravitreal implants, injection – related side effects are endophthalmitis, retinal detachment and bleeding. Sustained release of intravitreal implants of dexamethasone and fluocinolon reduce complications and decreased number of injections in the management of patients with diabetic macular edema.

Keywords:

corticosteroids, diabetic macular edema – dexamethasone – fluocinolone – retinal lasercoagulation – triamcinolone – vascular endothelial growing factor


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