糖尿病性黄斑水肿(DME)是糖尿病视网膜病变的严重并发症，其发病率随糖尿病患病率升高而递增，已成为导致视力丧失的重要原因。玻璃体腔抗血管内皮生长因子(VEGF)药物注射和激光光凝等传统治疗对部分难治性患者的疗效有限。近年来，DME治疗在机制研究和临床实践中取得显著进展。通过双靶点抑制的新型抗VEGF药物在改善视网膜形态方面展现出明显优势，该疗法注射间隔时间长，并发症少；激素治疗为难治性患者提供了新选择，但需警惕眼压升高和白内障等并发症的发生。抗VEGF联合地塞米松、激光光凝及口服药物的综合疗法可减少注射频率，发挥协同效应。玻璃体切除联合内界膜剥除术对难治性DME的解剖学改善存在争议，但在解除机械牵拉和清除炎症因子方面具有潜力，联合视网膜下注射技术可进一步清除硬性渗出。人工智能辅助预测抗VEGF治疗反应和基因治疗等新兴技术为个性化诊疗和长效干预带来了希望。尽管如此，DME发病机制的复杂性仍需深入探索，未来需聚焦长效药物研发、精准治疗策略及多中心临床验证，以优化患者的视力预后。

Diabetic macular edema (DME), a severe complication of diabetic retinopathy, exhibits an increasing occurrence rate in parallel with the rising prevalence of diabetes mellitus. It has emerged as a leading cause of vision loss, imposing substantial economic burdens on society and families. It has demonstrated that the conventional treatments, such as intravitreal anti-vascular endothelial growth factor (VEGF) injections and laser photocoagulation, had limited efficacy in certain refractory patient populations. In recent years, significant advancements have been achieved in both mechanistic studies and clinical management of DME: novel anti-VEGF agents featuring dual-target inhibition exhibit superior efficacy in improving retinal morphology with longer intervals of injection and lower complications. Corticosteroid therapy offers a viable alternative for refractory cases, though clinicians must remain vigilant against complications such as elevated intraocular pressure and cataract formation. Combination therapies, integrating anti-VEGF agents with dexamethasone, laser photocoagulation, or adjunctive medications, reduce injection frequency and exert synergistic therapeutic effects. Vitrectomy with internal limiting membrane peeling remains controversial regarding anatomical improvement in refractory DME; however, it holds potential in alleviating mechanical traction and clearing inflammatory mediators. Further refinement via subretinal injection techniques may enhance the clearance of hard exudates. Emerging technologies, including artificial intelligence assisted prediction of anti-VEGF response and gene therapy, present promising avenues for personalized treatment and sustained intervention. Despite these advances, the pathophysiology of DME remains incompletely elucidated. Future research should prioritize the development of long-acting therapeutics, precision medicine strategies, and multicenter clinical validation to optimize visual outcomes for patients.