Progress of the treatment of refractory macular edema

Refractory macular edema is a common manifestation of a variety of eye diseases, and it is one of the important causes of impaired vision in patients. The pathogenesis of macular edema is unclear, mainly related to the destruction of the retinal barrier, the expression of inflammatory factors, and the increase of vascular endothelial growth factor. Refractory macular edema is a recurrent disease, which has no response to drugs, seriously affecting vision. The main current clinical treatment is intravitreal anti-vascular endothelial growth factor injection. But for some of the patients who are insensitive to this treatment, intravitreal glucocorticoids injection is performed, but glucocorticoids have the risk of causing elevated intraocular pressure, so the safety of intravitreal glucocorticoids implant needs further study. Appropriate application of retinal laser photocoagulation can reduce the incidence of refractory macular edema, and help resolving the macular edema in some patients. Vitrectomy combined with internal limiting membrane peeling can relieve the tangential stress on the surface of macular and help to eliminate edema, but the surgical mechanical damage to the retina may not be beneficial to vision improvement. On the clinic, patients receive customize individualized treatment according to the pathogenesis, and if necessary, choose combined treatment to eliminate edema as soon as possible to avoid irreversible visual impairment. Key words: Edema, macular, refractory; Anti-vascular endothelial growth factor; Vitrectomy