*3.3.2 Anti-VEGF drugs*

The two anti-VEGF drugs Food and Drug Administration (FDA) approved and most commonly used are ranibizumab and aflibercept.


to the fragment crystallizable (Fc) segment of a human immunoglobulin G1 (IgG1). Aflibercept differs from the other anti-VEGF drugs, in that in addition to its binding capability to all isoforms of vascular endothelial growth factor A (VEGF-A) and vascular endothelial growth factor B (VEGF-B), it also binds to placental growth factor (PlGF) [70].


In the BOULEVARD trial, the patients who received 6.0 mg of faricimab did not need frequent re-treatments as compared to the group of patients who received ranibizumab [77].

In the YOSEMITE and RHINE trials, faricimab administered at 8- and at 16-week intervals was not inferior to Aflibercept administered every 8 weeks as regards visual improvement [78–81].

Several studies compared the efficacy of anti-VEGF drugs and laser treatment:

In all trials comparing Ranibizumab with sham injection (RESOLVE, RISE and RIDE), or with laser treatment (READ-2 and RESTORE), or in association with prompt and deferred laser (DRCR.net Protocol I), it was proved that Ranibizumab had better outcomes as compared to laser treatment for DME.

Similarly, studies with Aflibercept as DA VINCI (DME and VEGF trap-eye: investigation of clinical impact), Vision Impairment due to DME (VIVID-DME) and Study of Intravitreal Aflibercept Injection in Patients with Diabetic Macular Edema (VISTA-DME), also proved a better response with Aflibercept as compared to laser in the management of DME [82].

*Diabetic Macular Edema, Clinicopathologic and Keys for Management DOI: http://dx.doi.org/10.5772/intechopen.112974*

#### *3.3.3 Steroids*

1. *Triamcinolone acetonide (TA):* Intravitreal triamcinolone acetonide has not yet been approved for DME, however, in several studies its intravitreal use provided good visual acuity and anatomical improvements [83–85].

In pseudophakic eyes, the efficacy of Triamcinolone acetonide combined with laser therapy was found to be comparable to that of combined ranibizumab and laser therapy [86, 87].

The high incidence of glaucoma (about 44%) and cataract development (about 54%) make its use unsatisfactory [86, 87].
