Treatment Trends of Diabetic Macular Edema in Korea (TRACK) study: A Prospective Multicenter Study.

To evaluate real-world functional and anatomical outcomes, treatment patterns, and ocular examination trends in diabetic macular edema (DME) in Korea. A prospective, multicenter, observational study was conducted at 17 hospitals (2017-2022) involving adults with DME. Patients were categorized into center-involving (CI DME) and non-center-involving (non-CI DME) groups based on optical coherence tomography findings. Serial changes in best-corrected visual acuity (BCVA), central subfoveal thickness (CST), and treatment and examination patterns were recorded at baseline and follow-up visits (6, 12, 18, and 24 months), and analyzed using linear mixed models and paired t-tests. A total of 209 participants (38.8% women; mean age, 60.2±10.8 years) were enrolled. Over 24 months, 10/68 (14.7%) non-CI DME patients developed CI DME. CST significantly decreased in the CI DME group (from 419µm at baseline to 343µm, P=0.001), whereas BCVA remained unchanged in both groups. Throughout the two-year period, the average number of anti-VEGF injections was 3.1±3.6, while steroid injections averaged 0.7±1.5. The CI DME group received significantly more anti-VEGF injections compared to the non-CI DME group (3.8±3.9 vs. 2.0±2.8, P=0.004). Additionally, the CI DME group had more frequent visits (15.8 vs. 11.3, P=0.017) and OCT examinations (9.7 vs. 7.4, P=0.023). The number of anti-VEGF injections decreased in the CI DME group over time, while the number of visits decreased in both groups. In real-world clinical practice in Korea, the treatment and monitoring frequency for DME was lower than in major clinical trials, potentially contributing to suboptimal visual outcomes.