Abstract：
The high prevalence of Diabetic macular edema (DME) is a real global health problem. Its complex pathophysiology involves different pathways. Over the last decade, the introduction of intravitreal treatments has dramatically changed the management and prognosis of DME. Among the different treatment options, inhibitors of vascular endothelial growth factor (anti-VEGF) and intravitreal steroids implants represent the first-line therapy of DME. We conducted a review of electronic databases to compile the available evidence about the clinical management of DME in a clinical setting, with a special focus on treatment-naïve patients. Anti-VEGF therapies represent a valuable option for treating DME patients. However, many patients do not respond properly to this treatment and, due to its administration regimen, many patients receive suboptimal treatment in real life. Current evidence demonstrated that in patients with DME, DEX-i improved significantly both anatomic and visual outcomes. Besides eyes with insufficient anti-VEGF respond or recalcitrant DME cases, DEX-i can be effectively and safely used in treatment-naïve DME patients as first line therapy. DEX-i may be considered first line therapy in different clinical scenarios, such as DME eyes with a greater inflammatory component, patients with cardiovascular events, vitrectomized eyes, or those requiring cataract surgery. In conclusion, there are still many points for improvement pending in the clinical management of the patient with DME. Since DME treatment must follow a patient-tailored approach, selecting the best therapeutic approach for each patient requires a good understanding of the pathophysiology of DME.
摘要：
糖尿病性黄斑水肿（DME）的高患病率是一个真正的全球健康问题。其复杂的病理生理学涉及不同的途径。在过去的十年里，玻璃体内治疗的引入极大地改变了DME的治疗和预后.在不同的治疗方案中，血管内皮生长因子(抗VEGF)抑制剂和玻璃体内类固醇植入物代表了DME的一线治疗.我们对电子数据库进行了审查，以汇编有关DME在临床环境中的临床管理的可用证据。特别关注初治患者。抗VEGF疗法代表了治疗DME患者的有价值的选择。然而,许多患者对这种治疗没有适当的反应，由于其给药方案，许多患者在现实生活中接受了次优治疗。目前的证据表明，在DME患者中，DEX-i显著改善了解剖和视觉结果。除了抗VEGF反应不足或顽固性DME病例的眼睛外，DEX-i可以有效和安全地用于初治DME患者的一线治疗。DEX-i可能被认为是不同临床情况下的一线治疗，例如具有更大炎症成分的DME眼睛，心血管事件患者，玻璃体切除的眼睛,或需要白内障手术的人。总之,DME患者的临床治疗仍有许多需要改进的地方.由于DME治疗必须遵循患者量身定制的方法，为每位患者选择最佳治疗方法需要对DME的病理生理学有很好的了解.
