الفهرس 
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Abstract
Macular edema is defined as accumulation of fluid in the outer plexiform and inner nuclear layers of the retina, centered about the foveola.
The prevalence of Diabetic Macular edema, 200 million people worldwide, made the Search for and effective solution and treatment a major goal nowadays.
Diabetic macular edema (DME) is the most frequent cause of vision loss in patients with type 2 diabetes.
Diabetic macular edema represents a final common pathway response of the retina to a variety of possible pathways, usually involving retinal vasculature, several theories have been proposed to explain how BRB breakdown occur in macular edema.
However the pathophysiologic causes of diabetic macular edema is not fully understood yet.
Diagnosis of macular edema is made by stereoscopic fundus examination using slit-lamp biomicroscopy, in addition to fundus fluorescein angiography, however quantitative analysis of macular edema is only made nowadays using OCT.
For decades the Laser therapy and/or other treatment modalities were the most commonly preferred solution for its management but with guarded results limited to particular types of diabetic macular edema and also sight threatening side effects.
The limited outcome of other treatment modalities and the strong outcome of Steroids intravitreal injection -especially in some types as diffuse macular edema- draw the attention for the effectiveness and importance of steroid use in diabetic macular edema management.
In spite of the agreement on the importance and effectiveness of intravitreal route for steroids Injection due to its unique pharmacological specifications and strong anatomical and physiological barriers, however the need for reliable and constant release system became a must, not only because of the need for effective and constant release system but also to decrease the complications risk which rises with each intravitreal injection.
As the pathology of diabetic macular edema is a long lasting process the treatment modality must be a long lasting and effective one without exposing the patient to many drawbacks from the intervention each time.
The presence of already FDA approved slow release drug systems -other than steroids- opened the gate for the steroids slow release drug systems to evolve.
The crucial need to limit the frequency of repeated intraocular injections for the treatment of DME has enhanced the need for the development of slow-release devices.
The slow release steroids systems which are implanted intravitreally provides an effective, long lasting therapeutic release of steroids and eliminated the need for repeated injections with their undesired drawbacks.
Currently we have some products which are FDA approved as Posurdex (Allergan Inc., USA) and others waiting the approval, this will open and widen the use of these systems and will lead to more improvement in their effectiveness and less risk.
The availability of multiple steroid slow release systems and the beginning of their use on a wide scale will allow the monitoring of their effectiveness and their drawbacks.
Even if steroids have their own drawbacks as a material, the idea of the implant appears to be appealing and will encourage more and more ophthalmologists to use them.
As described in this review, most of the developed devices showed sustained release of steroids and induce marked therapeutic effects on DME
However, polymer degradation in the implants may cause toxicity and the need for challenging surgical techniques has hampered the further development of these systems for routine clinical use.
Therefore, additional studies to develop safe, innovative, efficient, sustained-release devices/system for steroid should be pursued in order to provide novel therapies to treat DME.