Management of diabetic macular edema: from anti-VEGF to emerging therapies

Diabetic macular edema (DME) is a frequent and vision-threatening complication of diabetes, arising from a complex interplay of inflammatory, vascular, and metabolic pathways. The advent of anti-vascular endothelial growth factor (anti-VEGF) therapy has fundamentally transformed DME management and is now established as the cornerstone of treatment. In this review, we provide an updated overview of current and emerging therapeutic approaches for DME. We summarize the clinical evidence supporting established anti-VEGF agents, including ranibizumab, aflibercept, and conbercept, as well as the complementary roles of intravitreal corticosteroids and subthreshold micropulse laser therapy. Particular emphasis is placed on recent advances, such as dual-pathway inhibition with faricimab, the potential retinal benefits of systemic agents including sodium-glucose cotransporter-2 inhibitors and metformin, and novel strategies aimed at improving treatment durability, including long-acting anti-VEGF formulations and gene-based therapies. Together, these developments reflect a shift toward more sustained, individualized, and mechanism-based management of DME.