Table 1

Intravitreal treatments for diabetic macular oedema (DMO)

Active substanceIndication in DMONICE technology appraisal guidanceCharacteristicsInjected dosePosology
Anti-VEGFRanibizumab (Lucentis)Treatment of visual impairment due to DMO in adults.41For treating visual impairment due to DMO only if the eye has a central retinal thickness of ≥400 µm at the start of treatment.7Fab fragment (no Fc portion).0.5 mg (0.05 mL)41One injection per month until maximum VA is achieved and/or there are no signs of disease activity. Thereafter, monitoring and treatment intervals should be determined by the physician.41
Aflibercept (Eylea)Treatment of visual impairment due to DMO in adults.42For treating visual impairment caused by DMO only if the eye has a central retinal thickness of ≥400 µm at the start of treatment.43Fusion protein (Fc-containing).2.0 mg (0.05 mL)42One injection per month for five consecutive doses, followed by one injection every 2 months. After 12 months, the treatment interval may be extended.42
Bevacizumab
(Off-label Avastin)
Not indicated in DMO.44Full-length monoclonal antibody (Fc-containing).1.25 mg9Not licensed, locally agreed.
CorticosteroidDexamethasone
(OZURDEX)
Treatment of adult patients with visual impairment due to DMO who are pseudophakic or who are considered insufficiently responsive to, or unsuitable for, non-corticosteroid therapy.25For treating DMO only if the implant is to be used in an eye with an intraocular (pseudophakic) lens and the DMO does not respond to non-corticosteroid treatment, or such treatment is unsuitable.45Biodegradable rod-shaped implant (6 mm×0.46 mm), injected with 22 G needle.25 46700 µg25One implant in the affected eye. Administration to both eyes concurrently is not recommended. Retreatment may be performed after approximately 6 months.*
Fluocinolone acetonide (ILUVIEN)Treatment of vision impairment associated with chronic DMO considered insufficiently responsive to available therapies.24For treating chronic DMO that is insufficiently responsive to available therapies only if the implant is to be used in an eye with an intraocular (pseudophakic) lens.47Non-bioerodible inert implant (3.5 mm×0.37 mm), injected with 25 G needle.34190 µg (0.2 µg/day)24One implant in the affected eye. Administration in both eyes concurrently is not recommended. An additional implant may be administered after 12 months.*
Triamcinolone acetonide
(Off-label Triesence)
Not indicated in DMO in the UK.An injectable suspension (40 mg/mL) approved in the USA for ocular inflammatory conditions unresponsive to topical corticosteroids.484 mg48Not licensed, locally agreed.
  • *If the patient experiences decreased vision and/or an increase in retinal thickness, secondary to recurrent or worsening DMO.

  • Fab, antigen-binding fragment; Fc, fragment crystallisable region; NICE, National Institute for Health and Care Excellence; VA, visual acuity; VEGF, vascular endothelial growth factor.