First-line treatment algorithm and guidelines in center-involving diabetic macular edema

Laurent Kodjikian, David Bellocq, Francesco Bandello, Anat Loewenstein, Usha Chakravarthy, Adrian Koh, Albert Augustin, Marc D. de Smet, Jay Chhablani, Adnan Tufail, Alfredo García-Layana, Aditya Sudhalkar, Thibaud Mathis

Research output: Contribution to journalReview articlepeer-review


Management of center-involving diabetic macular edema represents a real therapeutic challenge. Diabetic macular edema is the leading cause of visual acuity impairment in diabetic patients. Since the advent of intravitreal drugs, management of diabetic macular edema has significantly evolved. The historical grid laser photocoagulation is no longer recommended as first-line treatment of diabetic macular edema owing to the findings of the pivotal randomized controlled trials, and anti-vascular endothelial growth factor therapy has emerged as first-line therapy. Steroids also represent a valid treatment option in the management of naïve diabetic macular edema and their efficacy has also been confirmed in several studies. The optimal treatment for diabetic macular edema should consider both general and ophthalmological comorbidities. Patient compliance and motivation should also be carefully evaluated as some treatments require monthly follow-up. Based on recent literature evidence, the present review provides clinicians with a first-line treatment algorithm for center-involving diabetic macular edema tailored to the patient’s individual characteristics.

Original languageEnglish
Pages (from-to)573-584
Number of pages12
JournalEuropean Journal of Ophthalmology
Issue number6
Publication statusPublished - Nov 1 2019


  • algorithm
  • Center-involving diabetic macular edema
  • guidelines

ASJC Scopus subject areas

  • Ophthalmology


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