Macular Edema in Diabetes Medication

Updated: Feb 29, 2016
  • Author: Emmanouil Mavrikakis, MD, PhD; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

Medication Summary

As with all complications of diabetes, successful management of macular edema requires good control of the diabetes itself. A variety of intravitreal medications are currently available, with others under study. Medical treatment should focus on optimizing glycemic and hypertensive control and lowering lipid levels.

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Corticosteroids, Ophthalmic

Class Summary

Corticosteroids such as triamcinolone have anti-inflammatory effects and can be used for the treatment of diabetic macular edema.

Triamcinolone acetonide (Triesence)

Triamcinolone is a synthetic corticosteroid with anti-inflammatory effects. It is indicated for several ophthalmic diseases such as ocular inflammatory conditions and visualization during vitrectomy. Intravitreal triamcinolone is also being used in the treatment of diabetic macular edema.

Dexamethasone intravitreal implant (Ozurdex)

Dexamethasone intravitreal implant is indicated for the treatment of diabetic macular edema.

Fluocinolone intravitreal implant (Iluvien)

Corticosteroids are thought to act by inhibition of phospholipase A2 via induction of inhibitory proteins collectively called lipocortins; it is postulated that these proteins control biosynthesis of potent mediators of inflammation (eg, prostaglandins, leukotrienes) by inhibiting release of the common precursor, arachidonic acid. It is indicated for diabetic macular edema in patients who have been previously treated with a course of corticosteroids and did not have a clinically significant rise in intraocular pressure.

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Anti-VEGF Agents

Class Summary

Vascular endothelial growth factor (VEGF) increases retinal vascular permeability, causes breakdown of the blood-retina barrier, and results in retina edema. VEGF is up-regulated in diabetic retinopathy. Currently available anti-VEGF agents in the United States include pegaptanib sodium, ranibizumab, aflibercept, and bevacizumab. Bevacizumab is not commercially available as an intravitreal injection.

Ranibizumab (Lucentis)

Ranibizumab is a recombinant humanized antibody fragment that is active against all isoforms of VEGF-A. Intravitreal ranibizumab is FDA approved for the treatment of diabetic macular edema, exudative ARMD, and macular edema caused by retinal vein occlusion.

Aflibercept intravitreal (Eylea)

Aflibercept binds and prevents activation of vascular endothelial growth factors (VEGF-A) and placental growth factor (PIGF). It is approved for AMD, macular edema, and diabetic macular edema.

Pegaptanib (Macugen)

Pegaptanib sodium is a pegylated aptamer directed against the VEGF-A165 isoform. It was the first FDA-approved ophthalmologic anti-VEGF agent for the treatment of choroidal neovascularization (CNV) from age-related macular degeneration (ARMD).

Bevacizumab (Avastin)

Bevacizumab is a full-length recombinant humanized antibody that is active against all isoforms of VEGF-A. It is FDA approved as an adjunctive systemic treatment for metastatic colorectal cancer. Currently, a specific ophthalmic product is not available for intravitreal administration.

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