The Early Treatment Diabetic Retinopathy Study historical review and relevance to today’s management of diabetic macular edema

Curr Opin Ophthalmol 2017, 28:205–212

CI-DME VS NCI-DME

DRCR protocol –> I VS T

Diabetic Retinopathy Clinical Research

• The ETDRS demonstrated the benefit of laser treatment for clinically significant DME compared to the untreated clinical course.
• Modified ETDRS focal/grid laser photocoagulation for non-CI DME is still a reasonable option for many patients in today’s world.
• Subretinal fibrosis observed after focal/grid laser photocoagulation is related to the presence of severe hard exudates prior to laser photocoagulation.
• DRCR clinical trials (protocols I and T) for DME showed that the intravitreal anti-VEGF with or without laser is beneficial.
• In protocol I, pseudophakic eyes with DME treated with intravitreal steroids and prompt laser has similar visual acuity outcomes compared to intravitreal ranibizumab with prompt/deferred laser.

(1) Thickening of the retina at or within 500 μm of
the center of the macula.
(2) Hard exudates at or within 500 μm of the center
of the macula, if associated with thickening
of adjacent retina (not residual hard exudates
remaining after disappearance of retinal
thickening).
(3) A zone or zones of retinal thickening 1 disc area
or larger, any part of which is within 1 disc
diameter of the center of the macula.

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