Diabetic macular oedema — SCE Endocrinology MCQ
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Correct answer: C — Intravitreal anti-VEGF treatment with systemic risk-factor optimisation
The best answer is “Intravitreal anti-VEGF treatment with systemic risk-factor optimisation”. NICE recommends anti-VEGF treatment for centre-involving diabetic macular oedema with visual impairment when central retinal thickness is 400 micrometres or more; glucose and blood-pressure optimisation remain complementary. “Macular laser alone as mandatory first-line therapy at this thickness” is less appropriate because laser is not the recommended sole first-line choice for visually impairing centre-involving oedema at or above 400 micrometres “Annual screening without ophthalmology treatment” is less appropriate because sight-threatening disease requires treatment rather than routine screening recall “Topical corticosteroid drops for retinal oedema” is less appropriate because topical drops do not treat retinal vascular leakage at the macula “Immediate cataract surgery as the treatment for macular oedema” is less appropriate because lens surgery does not resolve diabetic macular oedema
Reference: NICE NG242: Diabetic retinopathy — management and monitoring. https://www.nice.org.uk/guidance/ng242/chapter/Recommendations