Diabetic macular oedema (DMO) is a common complication of diabetic retinopathy. The retina at the macula thickens and this can cause gradual loss of central vision. Grid or focal laser photocoagulation is effective in treating DMO and has been used for several years, but vision is rarely improved. Antiangiogenic therapy with anti-vascular endothelial growth factor (anti-VEGF) modalities has recently been proposed to try to improve vision in people with DMO. Anti-VEGF drugs are delivered by an injection in the vitreous cavity of the eye.
We included four studies in this review. We found two small studies, comparing pegaptanib with sham or bevacizumab with sham in patients with CSMO, that showed results in favour of antiangiogenic therapy but could not reliably demonstrate a benefit. An additional small study compared bevacizumab to photocoagulation in eyes with untreated CSMO and its results also favoured antiangiogenic therapy, but not reliably so. Other comparisons were between bevacizumab and triamcinolone, or between bevacizumab alone and bevacizumab plus triamcinolone in three studies which did not show a difference. Three out of the four studies were at risk of bias.
Antiangiogenic treatment was well tolerated in these studies, but since all studies were short-term, we were unable to investigate long-term effects as well as risks. Although several studies are ongoing, there is not sufficient high quality evidence on the use of anti-VEGF drugs for the treatment of DMO yet.