Diabetic retinopathy, the most common long-term complication of
diabetes mellitus, remains one of the leading causes of
blindness worldwide. Strict metabolic control, tight blood pressure control,
laser photocoagulation, and
vitrectomy remain the standard care for
diabetic retinopathy. Focal/grid
photocoagulation is a better treatment than intravitreal
triamcinolone acetonide in eyes with diabetic
macular edema and should be considered as the first-line therapeutic option. The current evidence suggests that intravitreal
triamcinolone acetonide or anti-
vascular endothelial growth factor agents result in a temporary improvement of visual acuity and a short-term reduction in central macular thickness in patients with refractory diabetic
macular edema and are an effective adjunctive treatments to
laser photocoagulation or
vitrectomy. However,
triamcinolone is associated with risks of elevated intraocular pressure and
cataract.
Vitrectomy with the removal of the posterior hyaloid without internal limiting membrane peeling seems to be effective in eyes with persistent diffuse diabetic
macular edema, particularly in eyes with associated vitreomacular
traction. Emerging
therapies include islet cell
transplantation,
fenofibrate,
ruboxistaurin, pharmacologic vitreolysis,
rennin-
angiotensin system blockers, and
peroxisome proliferator-activated receptor gamma agonists.