Corticosteroid Therapy In Diffuse Diabetic Macular Edema: Clinical Outcomes, Spectral Oct Findings, AndLessons For Current Practice

Dyck PJ, Kratz KM, Karnes JL, et al. The prevalence by staged severity of va- rious types of diabetic neuropathy, retinopathy, and nephropathy in a popu- lation-based cohort: the Rochester Diabetic Neuropathy Study. Neurology. 1993;43(4):817-824.

Leibowitz HM, Krueger DE, Maunder LR, et al. The Framingham Eye Study Monograph: an ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and vi- sual acuity in a general population of adults. Survey of Ophthalmology. 1980;24(Suppl):335-610.

Klein R, Klein BEK, Moss SE, et al. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, XIV: ten-year incidence and progression of diabetic retinopathy. Archives of Ophthalmology. 1994;112(9):1217-1228.

Ferris FL 3rd, Patz A. Macular edema: a complication of diabetic retinopathy.

Survey of Ophthalmology. 1984;28(Suppl):452-461.

Hikichi T, Fujio N, Akiba J, Azuma Y, et al. Association between the short- term natural history of diabetic macular edema and the vitreomacular relati- onship. Ophthalmology. 1997;104(3):473-478.

Stern AL, Taylor DM, Dalburg LA, Cosentino RT. Pseudophakic cystoid ma- culopathy: a study of 50 cases. Ophthalmology. 1981;88(9):942-946.

Bengisu Ü. Göz Hastalıkları. Ankara: Palme Yayıncılık; 1989:161-166.

Tasman W, Jaeger EA, Rullo C, Montzka D, Zacierka MD. Duane’s Clinical

Ophthalmology. Philadelphia: JB Lippincott Company; 1994.

Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology. Philadelphia: WB Saunders Company; 1994.

Yanoff M, Duker JS. Ophthalmology. 2nd ed. St. Louis: Mosby; 2004.

Flynn HW Jr, et al. Basic and Clinical Science Course, Section 12: Retina and Vitreous. San Francisco: American Academy of Ophthalmology; 2003- 2004.

Williams PL, Warwick R. Gray’s Anatomy. London: Churchill Livingstone; 1980:1163-1176.

Aydın P, Akova YA. Göz Hastalıkları. Ankara: Güneş Kitabevi; 2001:34-35.

Aydın P, Akova YA. Göz Hastalıkları. Ankara: Güneş Kitabevi; 2001:15-18.

American Academy of Ophthalmology. The Eye: Fundamentals and Prin- ciples of Ophthalmology, Section II. San Francisco: LEO; 2000:68-88.

Dyck PJ, Kratz KM, Karnes JL, et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neuro- logy. 1993;43(4):817-824.

Apaydın C. Anatomi. In: Aydın P, Akova YA, eds. Temel Göz Hastalıkları. Ankara: Güneş Kitabevi; 2001:18.

Frank RN. On the pathogenesis of diabetic retinopathy. Ophthalmology. 1991;98(5):586-593.

Buzney SM, Frank RN, Varma SD, et al. Aldose reductase in retinal mural cells. Investigative Ophthalmology & Visual Science. 1977;16(5):392-396.

Frank RN. Etiologic mechanisms in diabetic retinopathy. In: Ryan SJ, ed.

Retina, Vol. 2: Medical Retina. St. Louis: CV Mosby; 1989:301-326.

Frank RN, Keim RS, Kennedy A, Frank KW. Galactose-induced retinal ca- pillary basement membrane thickening: prevention by sorbinil and aldose reductase inhibition. Annotated bibliography, Department of Professional Information. Pfizer Inc.; 1985.

Frank RN. The aldose reductase controversy. Diabetes. 1994;43(2):169-172.

Cagliero E, Maiello M, Boeri D, Roy S, Lorenzi M. Increased expression of basement membrane components in human endothelial cells cultured in high glucose. Journal of Clinical Investigation. 1988;82(2):735-738.

Ashton N. Studies of the retinal capillaries in relation to diabetic and other retinopathies. British Journal of Ophthalmology. 1963;47:521-538.

Cogan DG, Toussaint D, Kuwabara T. Retinal vascular patterns, IV: diabetic retinopathy. Archives of Ophthalmology. 1961;66:100-112.

de la Rúbia G, Oliver FJ, Inoguchi T, King GL. Induction of resistance to endothelin-1’s biochemical action by elevated glucose levels in retinal peri- cytes. Diabetes. 1992;41(11):1533-1539.

Orlidge A, D’Amore PA. Inhibition of capillary endothelial cell growth by pe- ricytes and smooth muscle cells. Journal of Cell Biology. 1987;105(3):1455- 1462.

Ditzel J. Hypoxia as a pathogenic factor of microangiopathy with particular reference to diabetic retinopathy. Acta Endocrinologica. 1983;238(Suppl):39-55.

Bill A. Ocular circulation. In: Moses RA, ed. Adler’s Physiology of the Eye: Clinical Application. 7th ed. St. Louis: CV Mosby; 1981:193-194.

Sullivan PM, Davies EG, Cardwell G, Morris AH, Kohner EM. Retinal blood flow during hyperglycemia. Investigative Ophthalmology & Visual Science. 1990;31(10):2041-2045.

Pierce EA, Foley ED, Smith LEH. Regulation of vascular endothelial growth factor by oxygen in a model of retinopathy of prematurity. Archives of Oph- thalmology. 1996;114(10):1219-1228.

Aiello LP, Avery RL, Arrigg PG, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. New England Journal of Medicine. 1994;331(22):1480-1487.

Klein R, Klein BEK, Moss SE, et al. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, IV: diabetic macular edema. Ophthalmology. 1984;91(12):1464-1474.

Klein R, Klein BEK, Moss SE, et al. Association of ocular disease and morta- lity in a diabetic population. Archives of Ophthalmology. 1999;117(11):1487- 1495.

Diabetes Control and Complications Trial Research Group. Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications Trial. Ophthalmology. 1995;102(4):647-661.

Vitale S, Maguire MG, Murphy RP, et al. Clinically significant macu- lar edema in type I diabetes: incidence and risk factors. Ophthalmology. 1995;102(8):1170-1176.

Roy MS, Klein R. Macular edema and retinal hard exudates in African Ame- ricans with type 1 diabetes: the New Jersey 725. Archives of Ophthalmology. 2001;119(2):251-259.

Lopes de Faria JM, Jalkh AE, Trempe CL, et al. Diabetic macular ede- ma: risk factors and concomitants. Acta Ophthalmologica Scandinavica. 1999;77(2):170-175.

Klein BEK, Moss SE, Klein R, et al. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, XIII: relationship of serum cholesterol to retinopathy and hard exudate. Ophthalmology. 1991;98(8):1261-1265.

Chew EY, Klein ML, Ferris FL 3rd, et al. Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy: Early Treatment Di- abetic Retinopathy Study (ETDRS) Report 22. Archives of Ophthalmology. 1996;114(9):1079-1084.

Sinclair SH, Nesler C, Foxman B, et al. Macular edema and pregnancy in insulin-dependent diabetes. American Journal of Ophthalmology. 1984;97(2):154-167.

Best RM, Chakravarthy U. Diabetic retinopathy in pregnancy. British Jour- nal of Ophthalmology. 1997;81(3):249-251.

Sunness JS. The pregnant woman’s eye. Survey of Ophthalmology. 1988;32(4):219-238.

Meyers SM. Macular edema after scatter laser photocoagulation for pro- liferative diabetic retinopathy. American Journal of Ophthalmology. 1980;90(2):210-216.

McDonald HR, Schatz H. Macular edema following panretinal photocoagu- lation. Retina. 1985;5(1):5-10.

Jaffe GJ, Burton TC, Kuhn E, et al. Progression of nonproliferative diabe- tic retinopathy and visual outcome after extracapsular cataract extraction and intraocular lens implantation. American Journal of Ophthalmology. 1992;114(4):448-456.

Dowler JGF, Sehmi KS, Hykin PG, Hamilton AMP. The natural his- tory of macular edema after cataract surgery in diabetes. Ophthalmology. 1999;106(4):663-668.

Aiello LM. Diagnosis, management, and treatment of nonproliferative di- abetic retinopathy and macular edema. In: Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology. Philadelphia: WB Saunders; 1994:747-760.

Guillermo A-U, Ariadna S-L. Diabetic retinopathy. In: Agarwal S, Agarwal A, Apple DJ, Buratto L, Alió JL, Pandey SK, Agarwal A, eds. Textbook of Ophthalmology, Vol. 4: Retina and Vitreous, Systemic Diseases, Miscellane- ous. New Delhi: Jaypee; 2002:2560-2580.

Sahel JA, Brini A, Albert DM. Pathology of the retina and vitreous. In: Al- bert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology. Phi- ladelphia: WB Saunders; 1994:2239-2280.

Ashton N. Studies of the retinal capillaries in relation to diabetic and other retinopathies. British Journal of Ophthalmology. 1963;47:521-538.

Cogan DG, Toussaint D, Kuwabara T. Retinal vascular patterns, IV: diabetic retinopathy. Archives of Ophthalmology. 1961;66:100-112.

Engerman RL, Kern TS. Progression of incipient diabetic retinopathy during good glycemic control. Diabetes. 1987;36(7):808-812.

Kohner EM, Henkind P. Correlation of fluorescein angiogram and reti- nal digest in diabetic retinopathy. American Journal of Ophthalmology. 1970;69(3):403-413.

De Venecia G, Davis M, Engerman R. Clinicopathologic correlations in dia- betic retinopathy, I: histology and fluorescein angiography of microaneurys- ms. Archives of Ophthalmology. 1976;94(10):1766-1773.

Krupin T, Waltman SR, Szewczyk P, et al. Fluorometric studies on the blo- od-retinal barrier in experimental animals. Archives of Ophthalmology. 1982;100(4):631-634.

Gillies MC, Su T, Stayt J, et al. Effect of high glucose on permeability of retinal capillary endothelium in vitro. Investigative Ophthalmology & Visual Science. 1997;38(3):635-641.

Gardner TW, Lieth E, Khin SA, et al. Astrocytes increase barrier properties and ZO-1 expression in retinal vascular endothelial cells. Investigative Op- hthalmology & Visual Science. 1997;38(11):2423-2427.

Wallow IHL, Engerman RL. Permeability and patency of retinal blood ves- sels in experimental diabetes. Investigative Ophthalmology & Visual Scien- ce. 1977;16(5):447-461.

Vinores SA, Van Niel E, Swerdloff JL, Campochiaro PA. Electron mic- roscopic immunocytochemical evidence for the mechanism of blood-re- tinal barrier breakdown in galactosemic rats. Experimental Eye Research. 1993;57(6):723-735.

Begg IS, Rootman J. Clinico-pathological study of an organized plaque in exudative diabetic maculopathy. Canadian Journal of Ophthalmology. 1976;11(3):197-202.

Sigurdsson R, Begg IS. Organised macular plaques in exudative diabetic maculopathy. British Journal of Ophthalmology. 1980;64(6):392-397.

Bresnick GH. Diabetic maculopathy: a critical review highlighting diffuse macular edema. Ophthalmology. 1983;90(11):1301-1317.

Tso MOM, Cunha-Vaz JG, Shih CY, Jones CW. Clinicopathologic study of blood-retinal barrier in experimental diabetes mellitus. Archives of Ophthal- mology. 1980;98(11):2032-2040.

Early Treatment Diabetic Retinopathy Study Research Group. Focal photo- coagulation treatment of diabetic macular edema: relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseli- ne. ETDRS Report 19. Archives of Ophthalmology. 1995;113(9):1144-1155.

Thomas AC, Aiello LM, Zagorski B. Diabetic retinopathy and diabetic ma- cular edema. Diabetes Care. 2003;26(9):2653-2664.

Kadonosono K, Itoh N, Ohno S. Perifoveal microcirculation before and after vitrectomy for diabetic cystoid macular edema. American Journal of Opht- halmology. 2000;130(6):740-744.

Chung H, Park B, Shin HJ, Kim HC. Correlation of fundus autofluorescence with spectral-domain optical coherence tomography and vision in diabetic macular edema. Ophthalmology. 2012;119(5):1056-1065.

Kohner EM, Dollery CT, Paterson JW, Oakley NW. Arterial fluorescein stu- dies in diabetic retinopathy. Diabetes. 1967;16(1):1-10.

Hee MR, Puliafito CA, Wong C, et al. Quantitative assessment of macu- lar edema with optical coherence tomography. Archives of Ophthalmology. 1995;113(8):1019-1029.

Hee MR, Puliafito CA, Duker JS, et al. Topography of diabetic macular ede- ma with optical coherence tomography. Ophthalmology. 1998;105(2):360- 370.

Giovannini A, Amato G, Mariotti C, Scassellati-Sforzolini B. Optical co- herence tomography findings in diabetic macular edema before and after vitrectomy. Ophthalmic Surgery and Lasers. 2000;31(3):187-191.

Otani T, Kishi S. Tomographic assessment of vitreous surgery for diabetic macular edema. American Journal of Ophthalmology. 2000;129(4):487- 494.

Diabetes Control and Complications Trial Research Group. The effect of intensive diabetic treatment on the progression of diabetic retinopat- hy in insulin-dependent diabetes mellitus. Archives of Ophthalmology. 1995;113(1):36-51.

Klein R, Klein BEK, Moss SE, et al. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, IV: diabetic macular edema. Ophthalmology. 1984;91(12):1464-1474.

Roy MS, Klein R. Macular edema and retinal hard exudates in African Ame- ricans with type 1 diabetes: the New Jersey 725. Archives of Ophthalmology. 2001;119(2):251-259.

Lopes de Faria JM, Jalkh AE, Trempe CL, et al. Diabetic macular ede- ma: risk factors and concomitants. Acta Ophthalmologica Scandinavica. 1999;77(2):170-175.

Chew EY, Klein ML, Ferris FL 3rd, et al. Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy: ETDRS Report 22. Archives of Ophthalmology. 1996;114(9):1079-1084.

Early Treatment Diabetic Retinopathy Study Research Group. Focal photo- coagulation treatment of diabetic macular edema: relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseli- ne. ETDRS Report 19. Archives of Ophthalmology. 1995;113(9):1144-1155.

Bresnick GH. Background diabetic retinopathy. In: Retina. Toronto: CV Mosby; 1994:1277-1318.

Chew EY, Klein ML, Ferris FL 3rd, et al. Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy: ETDRS Report 22. Archives of Ophthalmology. 1996;114(9):1079-1084.

Klein BEK, Klein R, Moss SE. Is serum cholesterol associated with prog- ression of diabetic retinopathy or macular edema in persons with youn- ger-onset diabetes of long duration? American Journal of Ophthalmology. 1999;128(5):652-654.

Davis MD, Fisher MR, Gangnon RE, et al. Risk factors for high-risk pro- liferative diabetic retinopathy and severe visual loss: ETDRS Report 18. Investigative Ophthalmology & Visual Science. 1998;39(2):233-252.

Browning DJ, Zhang Z, Benfield JM, Scott AQ. The effect of patient cha- racteristics on response to focal laser treatment for diabetic macular edema. Ophthalmology. 1997;104(3):466-472.

Takagi H, Otani A, Kiryu J, Ogura Y. New surgical approach for removing massive foveal hard exudates in diabetic macular edema. Ophthalmology. 1999;106(2):249-256.

Aiello LM, Cavallerano JD, Aiello LP, Bursell SE. Diabetic retinopathy. In: Retina, Vol. 2: Medical Retina. Philadelphia: WB Saunders; 1999:316-344.

Bayraktar MZ. Diyabetik makula ödemi ve tedavisi. In: Eldem B, Aslan BS, Aydın P, Kasım R, Or M, Akata F, Can İ, Fırat E, Barlas B, eds. Makula Hastalıkları. Ankara: Şahin Matbaa; 2001:119-128.

Takagi H, Otani A, Kiryu J, Ogura Y. New surgical approach for removing massive foveal hard exudates in diabetic macular edema. Ophthalmology. 1999;106(2):249-256.

Nasrallah FP, Jalkh AE, Van Coppenolle F, et al. The role of the vitreous in diabetic macular edema. Ophthalmology. 1988;95(10):1335-1339.

Kadonosono K, Itoh N, Ohno S. Perifoveal microcirculation before and after vitrectomy for diabetic cystoid macular edema. American Journal of Opht- halmology. 2000;130(6):740-744.

Chung H, Park B, Shin HJ, Kim HC. Correlation of fundus autofluorescence with spectral-domain optical coherence tomography and vision in diabetic macular edema. Ophthalmology. 2012;119(5):1056-1065.

Pendergast SD, Hassan TS, Williams GA, et al. Vitrectomy for diffuse di- abetic macular edema associated with a taut premacular posterior hyaloid. American Journal of Ophthalmology. 2000;130(2):178-186.

Lewis H, Abrams GW, Blumenkranz MS, Campo RV. Vitrectomy for diabe- tic macular traction and edema associated with posterior hyaloidal traction. Ophthalmology. 1992;99(5):753-759.

Harbour JW, Smiddy WE, Flynn HW Jr, Rubsamen PE. Vitrectomy for dia- betic macular edema associated with a thickened and taut posterior hyaloid membrane. American Journal of Ophthalmology. 1996;121(4):405-413.

Hikichi T, Fujio N, Akiba J, Azuma Y, et al. Association between the short- term natural history of diabetic macular edema and the vitreomacular rela- tionship in type 2 diabetes mellitus. Ophthalmology. 1997;104(3):473-478.

Gandorfer A, Messmer EM, Ulbig MW, Kampik A. Resolution of diabetic macular edema after surgical removal of the posterior hyaloid and the inter- nal limiting membrane. Retina. 2000;20(2):126-133.

UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blo- od-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352(9131):854-865.

Pollack JS. Overview of the use of intravitreal steroids in retinal disease. American Academy of Ophthalmology Subspecialty Day, Anaheim, CA; 2003:14-15.

Jonas JB, Söfker A. Intraocular injection of crystalline cortisone as adjunc- tive treatment of diabetic macular edema. American Journal of Ophthalmo- logy. 2001;132(3):425-427.

Bonini-Filho MA, Jorge R, Barbosa JC, Calucci D, Cardillo JA, Costa RA. Intravitreal injection versus sub-Tenon’s infusion of triamcinolone acetoni- de for refractory diabetic macular edema: a randomized clinical trial. Inves- tigative Ophthalmology & Visual Science. 2005;46(10):3845-3849.

Schindler RH, Chandler DB, Thresher R, Machemer R. The clearance of intravitreal triamcinolone acetonide. American Journal of Ophthalmology. 1982;93(4):415-417.

Jonas JB, Kreissig I, Söfker A, Degenring RF. Intravitreal injection of tri- amcinolone acetonide for diabetic macular edema. Archives of Ophthalmo- logy. 2003;121(1):57-61.

Martidis A, Duker JS, Greenberg PB, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology. 2002;109(5):920-927.

Conway MD, Canakis C, Livir-Rallatos C, Peyman GA. Intravitreal tri- amcinolone acetonide for refractory chronic pseudophakic cystoid macular edema. Journal of Cataract & Refractive Surgery. 2003;29(1):27-33.

Antcliff RJ, Spalton DJ, Stanford MR, Graham EM, ffytche TJ, Marshall

J. Intravitreal triamcinolone for uveitic cystoid macular edema: an optical coherence tomography study. Ophthalmology. 2001;108(4):765-772.

Greenberg PB, Martidis A, Rogers AH, Duker JS, Reichel E. Intravitreal triamcinolone acetonide for macular edema due to central retinal vein occlu- sion. British Journal of Ophthalmology. 2002;86(2):247-248.

Jonas JB, Kreissig I, Degenring RF. Intravitreal triamcinolone acetonide as treatment of macular edema in central retinal vein occlusion. Graefe’s Arc- hive for Clinical and Experimental Ophthalmology. 2002;240(9):782-783.

Lewis H, Abrams GW, Blumenkranz MS, Campo RV. Vitrectomy for dia- betic macular traction and edema associated with posterior hyaloidal tracti- on. Ophthalmology. 1992;99(5):753-759.

Moshfeghi DM. Complications of intravitreal steroids. The Retina Debates, American Academy of Ophthalmology Subspecialty Day; 2003:65-68.

Tranos PG, Wickremasinghe SS, Stangos NT, Topouzis F, Tsinopoulos I, Pavesio CE. Macular edema. Survey of Ophthalmology. 2004;49(5):470- 490.

Cibis GW, Abdel-Latif AA, Bron AJ, et al. Basic and Clinical Science Course, Section 2: Fundamentals and Principles of Ophthalmology. San Francisco: American Academy of Ophthalmology; 2003-2004.

Danis RP, Ciulla TA, Pratt LM, Anliker W. Intravitreal triamcinolone aceto- nide in exudative age-related macular degeneration. Retina. 2000;20(3):244- 250.

Nelson ML, Tennant MTS, Sivalingam A, Regillo CD, Belmont JB, Marti- dis A. Infectious and presumed noninfectious endophthalmitis after intravit- real triamcinolone acetonide injection. Retina. 2003;23(5):686-691.

Moshfeghi DM, Kaiser PK, Scott IU, et al. Acute endophthalmitis fol- lowing intravitreal triamcinolone acetonide injection. American Journal of Ophthalmology. 2003;136(5):791-796.

Roth DB, Chieh J, Spirn MJ, Green SN, Yarian DL, Chaudhry NA. Nonin- fectious endophthalmitis associated with intravitreal triamcinolone injecti- on. Archives of Ophthalmology. 2003;121(9):1279-1282.

Rodriguez-Coleman H, Yuan P, Kim H, Zurakowski D, Whitcup SM, Csaky KG. Intravitreal injection of triamcinolone for diffuse macular edema. Arc- hives of Ophthalmology. 2004;122(7):1085-1086.

Aiello LP. The PKC-DRS Study: what happened. American Academy of Ophthalmology Subspecialty Day, Anaheim, CA; 2003:14-15.

Qaum T, Xu Q, Joussen AM, et al. VEGF-initiated blood-retinal barrier bre- akdown in early diabetes. Investigative Ophthalmology & Visual Science. 2001;42(10):2408-2413.

Das A, McGuire PG. Retinal and choroidal angiogenesis: pathophysio- logy and strategies for inhibition. Progress in Retinal and Eye Research. 2003;22(6):721-748.

Adamis AP. Looking forward: ocular biochemical warfare — the VEGF attack. American Academy of Ophthalmology Subspecialty Day, Orlando, FL; 2002:18-19.

Bresnick GH. Diabetic maculopathy: a critical review highlighting diffuse macular edema. Ophthalmology. 1983;90(11):1301-1317.

Bresnick GH. Diabetic macular edema: a review. Ophthalmology. 1986;93(7):989-997.

Klein R, Klein BEK, Moss SE, et al. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, IV: diabetic macular edema. Ophthalmology. 1984;91(12):1464-1474.

McDonald HR, Schatz H. Grid photocoagulation for diffuse macular ede- ma. Retina. 1985;5(2):65-72.

McCuen BW 2nd, Bessler M, Tano Y, Chandler D, Machemer R. The lack of toxicity of intravitreally administered triamcinolone acetonide. American Journal of Ophthalmology. 1981;91(6):785-788.

Koya D, King GL. Protein kinase C activation and the development of diabetic complications. Diabetes. 1998;47(6):859-866.

Martidis A, Duker JS, Greenberg PB, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology. 2002;109(5):920-927.

de Boer JF, Cense B, Park BH, Pierce MC, Tearney GJ, Bouma BE. Im- proved signal-to-noise ratio in spectral-domain compared with time-domain optical coherence tomography. Optics Letters. 2003;28(21):2067-2069.

Sanaka S, Yu M. Therapeutic outcomes of anti-VEGF agents versus corticosteroids in diabetic macular edema: a comparative review. Inter- national Journal of Molecular Sciences. 2026;27(3):1142. doi:10.3390/ ijms27031142.

Maturi RK, Glassman AR, Liu D, et al; Diabetic Retinopathy Clinical Re- search (DRCR) Network. Effect of adding dexamethasone to continued ra- nibizumab treatment in patients with persistent diabetic macular edema: a DRCR Network phase 2 randomized clinical trial. JAMA Ophthalmology. 2018;136(1):29-38. doi:10.1001/jamaophthalmol.2017.4914.

Faes L, Mishra AV, Lipkova V, et al. Visual and anatomical outcomes of a single intravitreal dexamethasone in diabetic macular edema: an 8-year real-world study. Journal of Clinical Medicine. 2023;12(12):3878. doi:10.3390/jcm12123878.

Wells JA, Glassman AR, Ayala AR, et al; Diabetic Retinopathy Clinical Re- search Network. Aflibercept, bevacizumab, or ranibizumab for diabetic ma- cular edema. New England Journal of Medicine. 2015;372(13):1193-1203.

Boyer DS, Yoon YH, Belfort R Jr, et al; Ozurdex MEAD Study Group. Three-year, randomized, sham-controlled trial of dexamethasone intra- vitreal implant in patients with diabetic macular edema. Ophthalmology. 2014;121(10):1904-1914.

Campochiaro PA, Brown DM, Pearson A, et al; FAME Study Group. Long- term benefit of sustained-delivery fluocinolone acetonide vitreous inserts for diabetic macular edema. Ophthalmology. 2011;118(4):626-635.

Wykoff CC, Abreu F, Adamis AP, et al. Efficacy, durability, and safety of intravitreal faricimab with extended dosing up to every 16 weeks in patients with diabetic macular oedema (YOSEMITE and RHINE): two randomised, double-masked, phase 3 trials. Lancet. 2022;399(10326):741-755.

Glassman AR, Wells JA 3rd, Josic K, et al; DRCR Retina Network. Af- libercept monotherapy or bevacizumab first for diabetic macular edema. New England Journal of Medicine. 2024;390(8):697-709. doi:10.1056/ NEJMoa2204225.