Diabetic Retinopathy with Center-Involved DME After Intravitreal Corticosteroids Have Not Achieved Visual Acuity Goals

This protocol applies to diabetic retinopathy complicated by center-involved diabetic macular edema (CI-DME) in patients who have progressed through prior lines of therapy, including intravitreal corticosteroids, without achieving the target outcomes.

Clinical Scenario

Diabetic macular edema is classified as center-involved (CI-DME) or non-center-involved (NCI-DME). Because the risk of visual loss is greatest when edema affects the center of the macula, CI-DME defines a distinct and more urgent management category.

Previous Treatment Failure

Next-line protocol

Prior therapy: Intravitreal corticosteroids, used as second-line therapy following suboptimal or no response to anti-VEGF therapy.

Goals not achieved: Reduction in central macular subfield thickness and improvement in visual acuity.

This protocol represents the clinical step taken when both of those goals remain unmet and substantial vitreomacular traction is part of the clinical picture.

Next-Line Approach

For diffuse CI-DME with substantial vitreomacular traction that has not responded to prior laser or intravitreal therapy, a surgical intervention may be considered in selected patients, with the goal of improving visual acuity.

The full eligibility criteria, decision algorithm, and procedural details are contained in the complete structured protocol.

Instant Access to Structured Evidence-Based Regimens

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.
When substantial vitreomacular traction is present, pars plana vitrectomy may improve visual acuity in selected patients who have diffuse DME that is unresponsive to previous macular laser photocoagulation surgery and/or anti-VEGF therapy.

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