Use of Corticosteroids in the Treatment of Patients With Diabetic Macular Edema Who Have a Suboptimal Response to Anti-VEGF: Recommendations of an Expert Panel

Ophthalmic Surg Lasers Imaging Retina. 2017 Apr 1;48(4):291-301. doi: 10.3928/23258160-20170329-03.

Abstract

Background and objective: Guidance on the use of corticosteroids in the treatment of diabetic macular edema (DME) is lacking. This study aimed to develop a clinically recommended treatment paradigm for DME with emphasis on the role of corticosteroids.

Patients and methods: An expert panel of nine retinal specialists in the United States developed consensus recommendations for DME treatment through a modified Delphi process.

Results: The panelists typically use intravitreal injections of vascular endothelial growth factor (VEGF) antagonists as first-line treatment of DME and switch patients with an inadequate response to anti-VEGF therapy (failure of best-corrected visual acuity to improve to 20/40 or better because of edema after three to six monthly injections, or a less-than-50% reduction in excess macular thickness after three to four monthly injections) to intravitreal corticosteroid treatment.

Conclusion: Intravitreal corticosteroids have a potentially useful role in the treatment of patients with DME who have an inadequate response to intravitreal anti-VEGF therapy. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:291-301.].

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angiogenesis Inhibitors / administration & dosage
  • Decision Making*
  • Delphi Technique
  • Diabetic Retinopathy / complications
  • Diabetic Retinopathy / diagnosis
  • Diabetic Retinopathy / drug therapy*
  • Expert Testimony / methods*
  • Follow-Up Studies
  • Glucocorticoids / administration & dosage*
  • Humans
  • Intravitreal Injections
  • Macular Edema / diagnosis
  • Macular Edema / drug therapy*
  • Macular Edema / etiology
  • Retrospective Studies
  • Surveys and Questionnaires*
  • Tomography, Optical Coherence
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors*
  • Visual Acuity

Substances

  • Angiogenesis Inhibitors
  • Glucocorticoids
  • Vascular Endothelial Growth Factor A