Use of corticosteroids in the treatment of patients with diabetic macular edema who have a suboptimal response to anti-VEGF: Recommendations of an expert panel

Background and Objective: Guidance on the use of corticosteroids in the treatment of diabetic macular edema (DME) is lacking. This study aimed to develop a clinically recommended treatment paradigm for DME with emphasis on the role of corticosteroids. Patients and Methods: An expert panel of nine retinal specialists in the United States developed consensus recommendations for DME treatment through a modified Delphi process. Results: The panelists typically use intravitreal injections of vascular endothelial growth factor (VEGF) antagonists as first-line treatment of DME and switch patients with an inadequate response to anti-VEGF therapy (failure of best-corrected visual acuity to improve to 20/40 or better because of edema after three to six monthly injections, or a less-than-50% reduction in excess macular thickness after three to four monthly injections) to intra-vitreal corticosteroid treatment. Conclusion: Intravitreal corticosteroids have a potentially useful role in the treatment of patients with DME who have an inadequate response to intravitreal anti- VEGF therapy.