Upcoming therapeutic advances in diabetic macular edema: an intravitreal dexamethasone drug delivery system

Introduction: Diabetes mellitus, through its ophthalmic complications diabetic retinopathy and diabetic macular edema (DME), is a leading cause of vision loss in industrialized countries. Areas covered: This review covers laser treatment, which is a standard treatment strategy that has proven efficacy and safety through large clinical trials in DME. Several intravitreal drug applications currently being investigated are also discussed. Expert opinion: First results suggest that the administration of anti-VEGF compounds is effective for DME. However, frequent injections may compromise safety. In order to enhance patient compliance, sustained delivery systems are being evaluated as potential treatment approaches. So far, only steroids have been included as active in such non-biodegradable or biodegradable delivery systems. Non-biodegradable systems are more complicated to administer as surgery is required and they need to be retrieved at the end of treatment. Also, in some cases safety issues have arisen, especially around intraocular pressure control. A new biodegradable dexamethasone delivery system seems to show promising efficacy results in addition to a more favorable safety profile, which will potentially improve patient compliance. All new therapeutic approaches, alone and in combination, will need to demonstrate their efficacy and safety in DME in future trials.