There are three major treatments of Diabetes-related Retinopathy and Diabetes-related Macular Edema which are effective to reduce vision impairment:
Laser photocoagulation is a well-proven therapy to reduce the risk of vision loss from diabetes-related macular edema. Treatments include the following:
Intravitreal injections of pharmacological agents, usually corticosteroids or anti-VEGF (Vascular Endothelial Growth Factor) agents, are injections into the vitreous gel inside the eye. More detail on anti-VEGF therapy can be found below. They are used alone or in combination with laser treatment to treat Proliferative Diabetes-related Retinopathy and Diabetes-related Macular Edema. Most patients will require at least 3-4 injections, initially at intervals of 4-6 weeks and may require further injections depending on the response to treatment.
Further detail on Anti VEGF therapy
The 3 most commonly utilised anti-VEGF agents — aflibercept, bevacizumab, and ranibizumab — are effective at improving vision over 1 and 2 years of treatment for Diabetes-related Macular Edema. However, on average, treatment with aflibercept provided superior visual gains at 1 year as compared with bevacizumab and ranibizumab. Aflibercept remained superior to bevacizumab, but not ranibizumab, based on mean visual acuity outcomes after 2 years of therapy. Although first-line therapy for most eyes with central-involved Diabetes-related Macular Edema consists of anti-VEGF, intravitreous injections of steroid can also be effective for Diabetes-related Macular Edema treatment. However, intravitreous steroid use is limited by more frequent ocular side effects, such as cataract and glaucoma.
Anti-VEGF is a viable treatment alternative to PRP in eyes with Proliferative Diabetes-related Retinopathy, especially for individuals with coexisting Diabetes-related Macular Edema that already necessitates anti-VEGF therapy. Eyes treated with anti-VEGF for Proliferative Diabetes-related Retinopathy have equivalent visual acuity outcomes at the 2-year endpoint of the study, compared with those treated with PRP laser. In addition, eyes treated with anti-VEGF exhibited better average visual acuity over the entire course of the 2-year study period. Additional benefits of anti-VEGF as compared with PRP laser include significantly less peripheral visual field loss, decreased rates of Diabetes-related Macular Edema onset, and fewer vitrectomies over 2 years.
Other anti-inflammatory compounds which may prove beneficial include:
Vitreoretinal surgery is used in for the treatment of Proliferative Diabetes-related Retinopathy where bleeding from the leaky vessels into the vitreous does not clear. Vitreoretinal surgery may also be required in cases of Proliferative Diabetes-related Retinopathy with retinal detachment to remove scar tissue attachments that may be distorting the retina and causing vision loss or wavy vision. Vitrectomy is a type of vitreoretinal surgery which can also be performed to treat Diabetes-related Macular Edema, particularly when there is an element of vitreoretinal traction leading to retinal thickening. Although retinal thickening is often improved after vitrectomy for Diabetes-related Macular Edema, visual outcomes are less certain, with approximately a third of patients experiencing substantial visual improvement, but between 20%–30% experiencing substantial visual loss after surgery.