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Evidence summaries

Intravitreal Steroids for Macular Edema in Diabetes

Intravitreal steroids (injection or implant) appear to improve visual outcomes in eyes with persistent or refractory diabetic macular edema. However, they increase the risk of intraocular pressure elevation and cataract progression. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 10 studies with a total of 4505 diabetic macular edema (DME) eyes. One trial (701 eyes ) compared intravitreal dexamethasone implant 0.7mg with sham, 2 trials with intravitreal antiVEGF, and 1 trial (560 eyes) compared intravitreal fluocinolone implant 0.19mg with sham. Visual acuity improved slightly with dexamethasone implant, but less than antiVEGF or fluocinolone implant. Two trials (615 eyes) compared intravitreal triamcinolone acetonide injection 4mg with laser photocoagulation, 1 (69 eyes) with sham, and 1 (30 eyes) with VEGF. Visual acuity improved slightly. Regarding adverse events, steroids increased the risk of cataract progression and the risk of using intraocular pressure lowering medications.

    References

    • Rittiphairoj T, Mir TA, Li T et al. Intravitreal steroids for macular edema in diabetes. Cochrane Database Syst Rev 2020;(11):CD005656. [PubMed]

Primary/Secondary Keywords