Macular oedema
Recommendations for cystoid macular oedema are listed in a separate pathway within the Inflammatory eye conditions section.
Aflibercept or faricimab are the preferred treatment options in DMO eyes with baseline BCVA below 69 letters. For baseline BCVA 69-75 letters ranibizumab is first-choice.
Specialist advice.
Specialist advice.
Specialist advice.
Specialist advice.
Specialist advice.
Specialist advice.
Specialist advice.
See prescribing notes for details of approved patient groups for use of Ozurdex and Iluvien.
Specialist advice.
Specialist advice.
Prescribing Notes:
- Vascular endothelial growth factor inhibitors (ranibizumab, aflibercept, brolocizumab and faricimab) are included on the formulary for Treatment of visual impairment due to diabetic macular oedema (DMO) in adults, restricted to treatment of visual impairment due to DMO in adults with best corrected visual acuity (BCVA) 75 Early Treatment Diabetic Retinopathy Study (ETDRS) letters or less at baseline. Vascular endothelial growth factor inhibitors are only to be administered by specailists experienced in the management of diabetic macular oedema.
- Use the vascular endothelial growth factor inhibitor of the lowest acquisition cost taking account of administration and monitoring costs.
- A brolucizumab MHRA drug safety update highlighted a risk of intraocular inflammation and retinal vascular occlusion which increases with short dosing intervals. Maintenance doses of brolucizumab (after the first 3 doses) should not be given at intervals of less than 8 weeks apart.
- Ozurdex is approved for treatment of adult patients with visual impairment due to diabetic macular oedema who are pseudophakic or who are considered insufficiently responsive to, or unsuitable for non-corticosteroid therapy.
- Iluvien is approved for treatment of vision impairment associated with chronic diabetic macular oedema, considered insufficiently responsive to available therapies. Restricted to use only in patients in whom the affected eye is pseudophakic (has an artificial lens after cataract surgery) and; retreatment would take place only if the patient had previously responded to treatment with fluocinolone acetonide and subsequently best corrected visual acuity had deteriorated to less than 20/32.
History Notes
27/02/2025
Update to prescribing information, ERFC Feb 25.
23/11/2023
Pathway updates including addition of Faricimab SMC2499, ERWG Jul 23.
08/02/2023
Addition of Eylea solution for injection pre-filled syringes, ERWG Jan 23.
15/06/2022
East Region Formulary content agreed.
Specialist advice.
Specialist advice.
Specialist advice.
Specialist advice.
Prescribing Notes:
- Ranibizumab is included on the formulary for the treatment of visual impairment due to macular oedema (MO) secondary to retinal vein occlusion (RVO) in adults.
- Aflibercept is included on the formulary for the treatment of visual impairment due to macular oedema secondary to branch retinal vein occlusion.
- Vascular endothelial growth factor inhibitors (ranibizumab and aflibercept) are only to be administered by specialists experienced in the management of macular oedema.
- Ozurdex is approved for treatment of adult patients with macular oedema following either branch retinal vein occlusion or central retinal vein occlusion. Restricted to use in adult patients with macular oedema (i) following central retinal vein occlusion (CRVO) and (ii) in patients with branch retinal vein occlusion (BRVO) who are not clinically suitable for laser treatment including patients with dense macular haemorrhage or patients who have received and failed on previous laser treatment.
History Notes
23/11/2023
Pathway updates, ERWG Jul 23.
08/02/2023
Addition of Eylea solution for injection pre-filled syringes, ERWG Jan 23.
15/06/2022
East Region Formulary content agreed.