Macular edema: A fearful complication of diabetic eye disease

Diabetic macular edema (DME) is a major complication of diabetic retinopathy. Risk factors for DME include hyperglycemia, high blood pressure, and dyslipidemia. The blood–retinal barrier (BRB) maintains fluid homeostasis necessary for normal retinal function. Pathophysiology of DME involves BRB disruption and is particularly driven by vascular endothelial growth factor (VEGF) and inflammatory cytokines. Anti-VEGF therapy is effective and has supplanted laser photocoagulation as first-line treatment for center involved DME. Ongoing research is exploring various approaches to extend the half-life of anti-VEGF agents as well as novel therapeutic drugs that may address non-VEGF mediated pathways.