Evolving Role of Regional Depot Corticosteroids in Management of Diabetic Macular Edema

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There are an estimated 382 million individuals who have diabetes mellitus worldwide and this number is projected to reach 592 million by the year 2035.1 Approximately 35% of diabetic patients will have some form of diabetic retinopathy (DR).2 Diabetic macular edema (DME) is the leading cause of vision loss in DR.1,2 The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR), a large population-based study, reported an incidence of DME of 29% in Type 1 diabetic persons over a period of 25 years.3 Similarly, the incidence of DME was reported as 25.4% in Type 2 diabetic persons requiring insulin.3 Proven preventive measures include lowering of high blood pressure and strict control of blood glucose.4,5 Multiple Level 1 clinical trials have shown the benefits of tight blood glucose control in preventing and/or slowing progression of DR, but “too tight control” in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) eye study resulted in increased mortality and cardiovascular complications.6 Furthermore, real-world data demonstrate the difficulty in achieving target blood glucose control and/or maintaining sustained control in most diabetic persons.7 Consequently, despite available measures and treatments, DR remains the leading cause of legal blindness among working-age adults.
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