Center-Involved Diabetic Macular Edema Persisting After Focal/Grid Laser Photocoagulation
Clinical Scenario
Diabetic macular edema is classified as either center-involved (CI-DME) or non-center-involved. The risk of visual loss is greatest when edema involves the center of the macula, making CI-DME the higher-priority subgroup that requires close management and, when needed, stepwise escalation of therapy.
Previous Treatment — Failure Condition
After CI-DME persisted despite anti-VEGF therapy, focal/grid laser photocoagulation (modified ETDRS technique) was performed as the next intervention. The intended outcome was resolution of persistent macular edema — a goal that was not achieved.
This protocol addresses the clinical step taken when that goal remains unmet.
Next-Line Approach
For CI-DME eyes with a suboptimal or absent response to prior therapies, an intravitreal corticosteroid strategy is considered as the next treatment step. The specific agents, selection criteria, and structured regimen are detailed in the full protocol.
Clinical goals include reduction in central macular (subfield) thickness and improvement in visual acuity.
References
- Diabetic macular edema should be classified as either center-involved (CI-DME) or non-center-involved DME (NCI-DME).
- Because the risk of visual loss is greatest if macular edema is at the center of the macula, DME is now subdivided as either CI-DME or NCI-DME.
- In DME eyes that have a suboptimal response or no response to anti-VEGF therapy, steroid therapy may improve visual and anatomic outcomes.
- Because of their side-effect profile, including cataract progression and elevated IOP, they are generally used as second-line agents for DME, especially for phakic patients.
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