Clinical Report: A Sequential Approach to DME
Overview
A novel sequential treatment regimen for diabetic macular edema (DME) shows comparable short-term outcomes to standard anti-VEGF therapy while significantly reducing the number of required intravitreal injections.
Background
Diabetic macular edema (DME) is a leading cause of visual impairment in working-age individuals, necessitating effective treatment strategies. Standard care typically involves multiple anti-VEGF injections, which can be burdensome for patients. Exploring alternative regimens that maintain efficacy while reducing treatment frequency is crucial.
Data Highlights
| Parameter | Sequential Regimen | Standard Regimen |
|---|---|---|
| Average Injections | 2.6 | 4.9 |
| BCVA Improvement | Significant | Significant |
| CMT Reduction | Significant | Significant |
| DME Recurrence | 0 | 3 |
Key Findings
- The sequential regimen involves one or two initial anti-VEGF injections followed by a dexamethasone implant and PRN anti-VEGF treatment.
- Both treatment approaches led to significant improvements in best-corrected visual acuity (BCVA) and central macular thickness (CMT).
- No statistically significant differences were found between the two regimens for key efficacy endpoints.
- Patients in the sequential group required nearly 48% fewer injections compared to the standard regimen.
- DME recurrence was observed in three eyes treated with the standard regimen but in none of the sequential regimen.
- Safety findings indicated elevated intraocular pressure in the sequential group, but no serious ocular adverse events were reported.
Clinical Implications
Clinicians should consider the treatment burden associated with the number of injections required for patients with DME.
Conclusion
The sequential treatment strategy for DME may maintain visual and anatomical outcomes while significantly reducing the number of required injections.
Related Resources & Content
- Retinal Physician, 2015 -- From Art to Science in DME Treatment
- Ophthalmology Management, 2015 -- The current-care toolbox for DME
- Corneal Physician, 2022 -- Paving the Way for Successful DMEK
- Nature, 2025 -- Clinical practice guidelines for the treatment and management of diabetic macular oedema: a systematic review
- PMC, 2026 -- Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes
- Ophthalmology Management — A Beginner’s Guide to DMEK
- Clinical practice guidelines for the treatment and management of diabetic macular oedema: a systematic review | Eye
- 12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2026 - PMC
- Faricimab Treat-and-Extend for Diabetic Macular Edema: Two-Year Results from the Randomized Phase 3 YOSEMITE and RHINE Trials - ScienceDirect
- Intravitreal Aflibercept 8 mg for Diabetic Macular Edema - Ophthalmology
- Intravitreal Aflibercept 8 mg for Diabetic Macular Edema: Ninety-Six-Week Results from the Randomized Phase 2/3 PHOTON Trial - PubMed
- Aflibercept 8 mg versus Faricimab Treat-and-Extend for Diabetic Macular Edema or Neovascular Age-Related Macular Degeneration: A Bayesian Fixed-Effect Network Meta-analysis of Clinical Trials
- Real-world injection burden, treatment switching, and visual outcomes in diabetic macular edema: a 563-eye cohort study | BMC Ophthalmology | Springer Nature Link
- Risk of Retinal Detachment After Intravitreal Injection of Anti-VEGF: A Systematic Review and Meta-Analysis - PubMed
Based on findings from:
A Sequential Approach to DME
The Ophthalmologist, 2026.
https://theophthalmologist.com/issues/2026/articles/august/a-sequential-approach-to-dme/
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