Vol. 10, Issue 11, Part D (2024)

Purpose: Diabetic macular edema (DME) is a leading cause of vision loss among patients with diabetic retinopathy, and vascular endothelial growth factor (VEGF) plays a key role in its pathogenesis. Anti-VEGF therapy has become the cornerstone of DME treatment, aiming to reduce vascular permeability and prevent fluid accumulation in the macula. This review provides an in-depth analysis of the mechanism, efficacy, safety, and limitations of anti-VEGF agents currently used for DME management, including ranibizumab, aflibercept, and bevacizumab.

Methods: A narrative review of the literature was conducted, focusing on key clinical trials, comparative studies, and expert opinions regarding the efficacy and safety of anti-VEGF agents in treating DME. Data were gathered from peer-reviewed journals, clinical trial results, and professional guidelines.

Results: Anti-VEGF agents such as ranibizumab, aflibercept, and bevacizumab have demonstrated significant efficacy in improving visual acuity and reducing macular thickness in patients with DME. Clinical trials such as RISE, RIDE, VIVID, and VISTA highlighted the effectiveness of ranibizumab and aflibercept in improving visual outcomes. Bevacizumab, although used off-label, is widely employed due to its cost-effectiveness, with comparative studies showing similar, though slightly inferior, results in patients with severe visual impairment. Despite their efficacy, these treatments often require frequent intravitreal injections, posing a challenge in terms of patient compliance and healthcare resource utilization. Adverse effects are generally mild, with injection-related complications being the most common.

Conclusion: Anti-VEGF therapy has revolutionized the management of DME, offering substantial visual benefits and improved quality of life for patients. However, treatment burden, variable patient responses, and the need for adjunctive therapies in refractory cases remain challenges. Future research is aimed at optimizing dosing regimens, developing longer-lasting therapies, and exploring novel targets in DME pathogenesis. Anti-VEGF agents will continue to play a central role in DME treatment as new approaches to improving their efficacy and durability are investigated.