Diabetic Macular Edema (DME)

Assesment

Mild to Moderate Moderate to severe

Noncentral-Involved Central Involved DME

VA better than 6/9 VA 6/9 (20/30) or central subfield thickness ≥ 250

VA 20/32 to 20/320
(20/30) worse microns

Focal or grid laser photocoagulation

1. Burn size 50-100 μm 2. 50-100 μm

3. Burn duration 0.05 to 0.1 sec 4. 0.05 to 0.1 sec
Anti VEGF Therapy Protocol I Protocol T
5. Green to yellow wavelengths 6. Green to yellow wavelengths
Anti VEGF Therapy Protocol I Protocol T

Shamp+Promt Ranibizumab+Pro triamcinolone+ Ranibizumab+ 2.0 mg/0.05mL 1.25mg/0.05mL 0.3mg/0.05mL

Laser mt Laser Promt Laser deferred Laser Aflibercept (Eylea) Bevacizumab Ranibizumab

injection every 4 weeks (within injection every 4 weeks with deferred

oneweek) focal/grid photocoagulation (≥24 weeks) focal/grid hotocoagulation
 Injection every 4 weeks until stable.
 Starting at the 6-month visit, laser
treatment was administered if DME
 Follow-up was planned for 3 years persisted and was not improving.
 the primary outcome at 1 year
 During the first year, follow-up visits occurred every 4 weeks (±1
week)
 After the first year, visits occurred every 4 to 16 weeks depending
on the treatment group, disease course, and treatment
administered

Vitrectomy:
1. Severe vitreous hemorrhage of 1–3 months duration or longer that does not clear spontaneously.
2. Advanced active proliferative DR that persists despite extensive PRP.
3. Traction macular detachment of recent onset.
4. Combined traction-rhegmatogenous retinal detachment.
5. Tractional macular edema or epiretinal membrane involving the macula.
International Council of Ophthalmology (ICO) for Diabetic eye care,2017

Ammary-Risch, Neyal J., Emily Y. Chew, Judy E. Kim. 2016. Advances in the Treatment of
Diabetic Retinopathy:Paradigm shifts in patient care and education. National eye institute