Abstract
The antivascular endothelial growth factor (VEGF) ranibizumab (Lucentis) and aflibercept (EYLEA) and the intraocular corticosteroids dexamethasone (Ozurdex) and fluocinolone acetonide (ILUVIEN) are approved for treating diabetic macular edema (DME) in the US. Here, we review each therapy and consider the advantages of administering a corticosteroid as a slow-release implant. A suboptimal response is seen in about 50 % of DME patients treated with anti-VEGF therapy. In such patients corticosteroids are an attractive alternative. Treatment with a course of corticosteroids to indicate if a clinically significant rise in intraocular pressure may occur is required before commencing ILUVIEN. Then the physician can make a clinical decision on the treatment. ILUVIEN offers the advantage of providing 36 months of drug release from a single implant. With the availability of four drugs to treat DME, it is important to consider the optimal treatment for the individual patient.