Are steroid eye injections effective and safe for treating diabetic macular edema (DME)?

This study compared the use of steroid eye injections with other treatments for diabetic macular edema (DME). They found that steroid injections may improve vision slightly compared to placebo, but are possibly less effective than other types of injection. Steroid injections also increase the risk of cataracts and increased pressure in the eye.

Diabetic macular edema (DME) is a condition involving fluid building up in the retina at the back of the eye. This fluid affects the central vision and can lead to significant sight loss. Treatments include two types of eye injections, using steroids or anti-vascular endothelial growth factor (anti-VEGF) drugs. Laser surgery is another option. It is not clear which treatment is most effective in patients with DME.

This study compared the results of 10 studies. Altogether 4,348 patients were involved in these studies. These studies compared steroid eye injections with either placebo or another treatment. Patients were followed up for 9 to 36 months and monitored for a change in vision and any side effects.

Patients treated with steroid eye injections showed a slight improvement in vision compared to placebo treatment. These patients could read an average of 2-6 more letters on the chart. However, patients treated with steroid eye injections had higher risks of cataracts and high eye pressure. 

Patients treated with steroid eye injections had similar or slightly less improvement in vision than patients treated with anti-VEGF eye injections. Patients treated with steroid injections had more than 4 times higher risks of cataracts compared to anti-VEGF injections. There was no sufficient data to compare steroid eye injections to laser surgery for DME.

This study showed that steroid eye injections may improve vision compared to placebo and they are probably less effective than anti-VEGF eye injections. Steroid eye injections are also associated with an increased risk of cataracts and high eye pressure.

The evidence in some of these studies was not very high quality and may compromise these results. More studies are required.