Recent Advances in The Management of Diabetic Macular Edema

Diabetic macular oedema (DME) is a vision-threatening complication of diabetic retinopathy caused by breakdown of the retinal vascular barrier and accumulation of intraretinal or subretinal fluid. Optical coherence tomography (OCT) has transformed diagnosis and treatment monitoring. Intravitreal anti–vascular endothelial growth factor (anti-VEGF) therapy remains the principal treatment for centre-involving DME, but repeated injections create a substantial burden for patients and health-care systems. Recent developments aim to improve durability without compromising vision. Faricimab, a bispecific antibody targeting VEGF-A and angiopoietin-2, permits personalised dosing intervals of up to 16 weeks in appropriately responding eyes. The ranibizumab port-delivery system (PDS) provides continuous drug delivery with refill exchanges every 24 weeks and was noninferior to monthly ranibizumab in the PAGODA randomised trial. Corticosteroid implants remain useful in selected eyes, particularly when anti-VEGF response is inadequate, although cataract formation and intraocular-pressure elevation require careful monitoring. This review summarises current evidence, practical treatment considerations, limitations, and future directions in sustained drug delivery for DME.