Research Progress on Individualized Treatment of Diabetic Macular Edema

Diabetic macular edema (DME) is the leading cause of vision impairment in diabetic patients. Although anti-VEGF agents are the first-line treatment, challenges such as drug resistance, frequent injections, and refractory cases persist. This article systematically reviews optimization strategies for DME treatment: regarding first-line anti-VEGF therapy, it discusses drug alternative regimens, precision treatment based on OCT classification, and the application of novel bispecific antibody drugs and sustained-release delivery systems; for refractory DME, it analyzes glucocorticoid alternative therapy, methotrexate application, and surgical interventions such as cystotomy and precise laser photocoagulation; in view of the high incidence of DME after cataract surgery in diabetic populations, it elaborates on perioperative prevention and control strategies from the aspects of systemic metabolic management, OCT and OCTA imaging evaluation, artificial intelligence prediction models, and aqueous humor inflammatory factor monitoring; finally, it prospects future research directions such as nanotechnology, biomarker-targeted therapy, and nutritional metabolic intervention, aiming to provide references for clinical individualized precision treatment.