Diabetic macular edema (DME) is a common complication of diabetic retinopathy that affects the macula, the central part of the retina responsible for detailed vision. It occurs when blood vessels in the retina leak fluid, causing swelling that can lead to vision loss. Treating DME promptly is crucial to preserving eyesight. Eye injections have become a standard and effective therapy for managing this condition.
Understanding Diabetic Macular Edema
DME develops when diabetes damages the small blood vessels in the retina, causing leakage of fluid and protein into the macula. The swelling disrupts the fine balance needed for sharp, central vision necessary for reading, driving, and recognizing faces. Without treatment, DME can progress to significant vision impairment or blindness.
Role of Eye Injections in Treatment
Medications delivered directly into the eye target the underlying causes of swelling and help reduce fluid buildup. Eye injections allow the drugs to reach the retina efficiently, providing more effective results than oral medications or eye drops.
The primary goals of injection therapy are to decrease macular swelling, stabilize or improve vision, and prevent further progression of diabetic eye disease.
Anti-VEGF Injections
The most common treatments for DME are anti-vascular endothelial growth factor (anti-VEGF) injections. VEGF is a protein that promotes the growth of abnormal blood vessels and increases vascular permeability, leading to leakage and edema.
Anti-VEGF drugs block the action of VEGF, reducing leakage and swelling in the retina. The most widely used anti-VEGF agents include ranibizumab, aflibercept, and bevacizumab. These medications have been extensively studied and shown to improve vision in many patients with DME.
Anti-VEGF injections are typically administered monthly or as needed, based on patient response. Regular monitoring by an eye specialist guides treatment intervals.
Corticosteroid Injections
In cases where patients respond inadequately to anti-VEGF or cannot receive these medications, corticosteroid injections may be used. Steroid injections reduce inflammation and edema by suppressing immune responses and stabilizing blood vessels.
Common corticosteroids for DME include triamcinolone acetonide and dexamethasone implants. The implants provide sustained drug release over several months, reducing the need for frequent injections.
While effective, steroids carry risks such as increased intraocular pressure and cataract formation, requiring close monitoring.
Combination and Adjunct Therapies
Sometimes physicians combine anti-VEGF and steroid treatments or use injections along with laser therapy to optimize outcomes. Combination therapy may be recommended for persistent or severe edema.
The treatment approach depends on individual factors such as disease severity, prior response to therapy, and overall eye health.
Injection Procedure and Safety
Injections are performed in a sterile clinical setting to minimize infection risk. The eye is numbed with anesthetic drops, and antiseptic is applied to the eyelids and surface. Using a fine needle, the medication is injected into the vitreous cavity near the retina.
Most patients tolerate the procedure well, experiencing only mild discomfort. Side effects like eye redness, irritation, or floaters may occur temporarily.
Serious complications such as infection, bleeding, or retinal detachment are rare but require immediate medical attention.
Importance of Follow-Up Care
Successful management of DME with eye injections relies on regular follow-up visits. Eye exams, optical coherence tomography (OCT) imaging, and visual acuity testing monitor treatment effectiveness and detect complications.
Adherence to the treatment schedule improves the chances of vision preservation and reduces the risk of worsening edema.