In diabetic macular edema (DME), center-involving macular edema with best corrected visual acuity of 6/18 or worse is currently best treated with:
- A Focal/grid macular laser photocoagulation as first-line
- B Pars plana vitrectomy with internal limiting membrane peeling
- C Intravitreal anti-VEGF agents (e.g., ranibizumab, aflibercept) as first-line ✓
- D Intravitreal dexamethasone implant (Ozurdex) as first-line in all patients
Correct answer: C. Intravitreal anti-VEGF agents (e.g., ranibizumab, aflibercept) as first-line
Explanation
Current international guidelines (DRCR.net Protocol T, EURETINA) recommend intravitreal anti-VEGF therapy as the first-line treatment for center-involving DME with vision impairment (VA 6/18 or worse). Macular laser is now second-line or adjunctive. Vitrectomy is reserved for tractional or refractory cases with vitreomacular traction. Dexamethasone implant is useful for pseudophakic or anti-VEGF-resistant cases but not universally first-line due to cataract and IOP risks.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.