Trends in treating chronic persistent diabetic macular edema

Diabetic macular edema (DME) induced by increasing vascular leakage due to thickened basement membrane, thus will lead to early reduction of vision in working age group,1 DME previously treated with laser and intravitreal steroids (triamcinolone acetonide) in the pre Anti-VEGF era; however, intravitreal Anti-VEGF injection gained popularity due to easy administration, safe profile and good efficacy. Chronic persistent DME presents as long-standing DME usually more than 18 months, which features diffuse pattern, OCT may show photoreceptor layer loss, and usually responds poorly to Anti-VEGF. Usually response to Anti-VEGF treatment is poor when OCT fails to show reduction of retinal thickness of less than 10% or/and BCVA improvement after six injections, then DME deemed as chronic, and treatment should be changed to intravitreal steroids, because inflammatory mediators are the main driver of DME.