Early intravitreal corticosteroids for diabetic macular edema gain momentum

Traditionally considered a second-line treatment due to associated risks, intravitreal corticosteroids, particularly the dexamethasone (DEX) intravitreal implant, are gaining attention for potential primary or early use in the management of diabetic macular edema (DME), according to a new study.

The shift is driven by increasing evidence highlighting the crucial role of inflammation in DME pathogenesis.

The review underscores the efficacy and safety of DEX implant, especially in specific clinical scenarios where it may be considered or preferred as a first-line treatment. These scenarios include patients with contraindications to anti-VEGF, those with high inflammatory biomarkers, pseudophakic individuals, and phakic patients candidates for cataract surgery, as well as vitrectomized eyes.

In addition, the review suggests that DME non-responders to anti-VEGF may benefit from a switch to DEX implant, and a combination therapy of DEX implant and anti-VEGF could be a valid option in severe and persistent cases of DME.

Reference
Taloni A, Coco G, Rastelli D, et al. Safety and Efficacy of Dexamethasone Intravitreal Implant Given Either First-Line or Second-Line in Diabetic Macular Edema. Patient Prefer Adherence. 2023;17:3307-3329. doi: 10.2147/PPA.S427209. PMID: 38106365; PMCID: PMC10725633.