Efficacy of topical corticosteroids and non-steroidal anti-inflammatory drugs for the treatment of diabetic macular oedema not in the context of intra-ocular surgery: a systematic review

Purpose The aim of this systematic review was to assess whether current best evidence supports the use of topical anti-inflammatory medications for diabetic macular oedema (DMO). Methods A systematic review, limited to randomised controlled studies published from 2015 onwards, was carried out. MEDLINE, EMBASE, PubMed, Scopus, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched on the 11 ^th October 2024. Subjects with DMO treated with topical corticosteroids or non-steroidal anti-inflammatory drugs (NSAIDs) were included. The effect on central macular thickness was the primary outcome of interest. Results Seven out of the eight studies included partly/fully support the use of topical anti-inflammatory therapy to reduce macular thickness in DMO. Studies were very heterogenous and no meta-analysis was possible. The overall quality of the evidence was deemed to be moderate. Conclusion Topical corticosteroids and NSAIDs may be a viable therapeutic strategy for DMO. However, further studies are required to assess which agents and regimens would be most beneficial, and to allow better patient selection for this approach. Drugs with improved ocular penetration and efficacy may improve the success of this approach.