Although the pathogenesis of DMO is not fully understood, it involves three main components [2]. Vascular component, mediated by vascular endothelial growth factor (VEGF) including microaneurysms development and breakdown of blood–retina barrier. An inflammatory process in which pro-inflammatory proteins lead to capillary degeneration and pericyte loss. There is also a neurodegenerative process contributing to the pathological cascade.

Why then steroids, targeting the inflammatory part, should not be part of our armamentarium in treating DMO. According to recent PAT survey of the ASRS, over two thirds of ophthalmologists worldwide choose anti-VEGF as their first line of treatment of DMO [3]. By combating inflammatory cytokines, steroids have at least a theoretical role in the management of this disease. Moreover, as has been shown by the Diabetic Retinopathy Clinical Research Network (DRCRnet) protocol I and protocol T, over 40% of patients still had persistent DMO despite adequate treatment with anti-VEGF [4, 5]. We have identified some subgroups of patients with DMO in whom steroids should be considered over the course of their disease management.