The current role of steroids in diabetic macular edema

Introduction: Given the role of inflammation in the pathogenesis of diabetic macular edema (DME), the use of intravitreal corticosteroid agents can be a valid therapeutic alternative in the management of DME. Areas covered: A PubMed-based search was carried out using the terms “Diabetic macular edema’, ‘diabetic maculopathy’, ‘Dexamethasone’, ‘Fluocinolone acetonide’, and ‘Triamcinolone acetonide’. All studies published in English up to October 2019, irrespective of their publication status, were included in this review. Data from international expert meetings and consensuses were also considered in the dissertation. Expert opinion: Intravitreal devices releasing corticosteroids are safe, effective, and well-tolerated. Steroids should be considered in patients with unsatisfactory response to a first-line trial of anti–vascular endothelial growth factor (VEGF) therapy. Early switch is recommended to avoid irreversible retinal damage due to long-standing DME. Patients should be monitored for cataract worsening or intraocular pressure rise.