Biomarkers are defined as measurable objective indicators that can be used to assess normal physiological process, pathological process and/or tissue response to pharmacological therapeutic agents. In this review article, we address the most notable structural changes encountered in DME patients and their impact on treatment planning and outcomes.

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The Diabetic Retinopathy Clinical Research Network (DRCR) retina network was formed in 2002 through a United States National Eye Institute and National Institute of Diabetes and Digestive and Kidney Diseases-sponsored cooperative agreement with the objective of creating a collaborative network for multicenter clinical trials focusing on diabetic retinopathy (DR) and its associated complications. The DRCR Retina Network has initiated and completed 30 multicenter studies in over 350 clinical sites. The goals of the DRCR was to design, implement, and report clinical studies that would answer important questions related to clinical practice and management of DR as well as DME. Diabetic macular edema (DME) is the leading cause of vision loss in the working age population and until the turn of the century the treatment options were limited to macular laser. This review aims to summarize the major DME studies completed by the DRCR The current review covers the major clinical trials that have helped help establish the current standard of care in the management of DME including protocols A, B, I, T, U and V.

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Literature review for surgical management for both tractional and non-tractional diabetic macular edema; with and without internal limiting membrane peeling. According to the DRCR prospective study, traction relaxation allowed vision gain and reduction in central foveal thickness in tractional diabetic macular edema. Also data from small scale and pilot studies about the role of pars plana vitrectomy for non-tractional CI-DME management, showed visual gain and edema resolution in both naive and refractory cases. It is concluded that pars plana vitrectomy has a role the management of DME; however, large scale trials are needed to define the role, optimum timing, and patients characteristics for the usage of vitrectomy in non-tractional DME management.

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Laser photocoagulation has been an integral part of the management of diabetic macular edema (DME) for decades. And despite the dramatic changes in retinal imaging and the availability of new treatment options over the years it is still has a role in the pharmacotherapy era. First, as a supplementary treatment in eyes with CI-DME inadequately responding to antiVEGFs and steroids; to reduce the number and frequency of injections. And secondly, it is the only scientifically proven option for eyes with non CIDME with CSME features.

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