Topical NSAIDs Offer Minor Improvements for DME Alongside Anti-VEGF Therapy

Anti-VEGF injections are the primary and most effective known treatment for DME management, but some topical NSAIDs that are able to penetrate into the eye’s posterior segment may be helpful as an addition to standard treatment. Photo: Erik Hanson, MD. Click image to enlarge. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) produced a small improvement in visual acuity but did not significantly reduce central macular thickness or macular volume in diabetic macular edema (DME), according to a study published in BMC Ophthalmology.The authors evaluated how topical NSAIDs affected the treatment of DME either alone or as an adjunct to intravitreal anti-VEGF therapy. The authors followed PRISMA guidelines and looked at studies from five different databases, choosing both interventional and observational human studies that compared topical NSAIDs with anti-VEGF monotherapy, placebo or no treatment. Six studies met inclusion criteria, with a total of 446 patients (892 eyes). Study designs included four randomized controlled trials, one pilot study and one retrospective observational study. The follow-up periods ranged from six weeks to 12 months. Specific demographic information was limited, but participants primarily had diabetes, as well as varying stages of diabetic retinopathy and DME.They included the use of topical agents such as bromfenac, ketorolac and nepafenac and found that there was a significant improvement in BCVA when treatment incorporated NSAIDs. However, the authors also noted in the study that “further exploration, larger-scale studies, and individualized treatment approaches are warranted to establish their long-term efficacy and safety profiles.” Four studies assessing CMT showed a reduction that was not considered significant, and an analysis of patients’ macular volumes across several studies also showed a mean difference of only 0.29 mm³.The researchers concluded that topical NSAIDs demonstrate some benefit when combined with anti-VEGF therapy during the treatment of DME, but that they do not show consistent improvement across all treatment cases and require further research to confirm whether they are a truly beneficial supplement to treatment.IMG CAP: Anti-VEGF injections are the primary and most effective known treatment for DME management, but some topical NSAIDs that are able to penetrate into the eye’s posterior segment may be helpful as an addition to standard treatment.Click here for the source. AlShimali R, Jamal L, Khorsheed S, et al. Efficacy of topical nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of diabetic macular edema (DME): a systematic review and meta-analysis. May 7, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.