Throwback Series: Managing bilateral diabetic macular edema early in practice

In celebration of Ophthalmology Times’ 50th anniversary, leaders revisit a memorable “throwback” case from earlier in their careers. In this special series, they reflect on how evolving knowledge, techniques, and technologies have transformed the way such cases are managed today. Join us as we look back at pivotal moments in their professional journeys — and explore how far the field has come.

This episode features a case from early in the career of the ophthalmologist—David Eichenbaum, MD, FASRS—soon after fellowship in Boston, involving bilateral diabetic macular edema. Treated with frequent intravitreal triamcinolone, the patient developed severe steroid-induced glaucoma requiring valves in both eyes. The case highlights the shift to today’s safer, more effective anti-VEGF and next-generation antiangiogenic options.

Eichenbaum, from Retina Vitreous Associates of Florida in Tampa, recalls an early career “throwback case” highlighting how far diabetic macular edema (DME) management has evolved. In 2007, shortly after fellowship at Tufts New England Eye Center and Ophthalmic Consultants of Boston—“where intravitreal triamcinolone was essentially born as an evidence-based treatment for diabetic eye disease”—he treated a patient with bilateral DME using frequent intravitreal triamcinolone injections. The patient developed a severe steroid-induced glaucoma, ultimately requiring valve implants in both eyes “for the purpose of continuing to inject with intravitreal triamcinolone.”

Reflecting on this experience, Eichenbaum noted, “Seems like the Middle Ages, man,” underscoring how much the therapeutic landscape has changed, including the use of antiangiogenics—and even second-generation antiangiogenic therapies—markedly reducing the need for steroids and associated surgical interventions.

Eichenbaum emphasized that contemporary treatments have lessened patient burden and improved safety, yet innovation continues to push the field forward.

As he concluded, “We’ve come a long way, and we’ve got a long way yet to go together.” This retrospective illustrates both the progress in retinal therapeutics and the continuing drive toward safer, more durable disease control.