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Avastin is an anti vascular endothelial growth factor (anti-VEGF) antibody FDA approved for colon cancer. It is the parent drug of Lucentis. The manufacturer made the molecule (Lucentis) smaller, so that it can penetrate the eye better. Most studies show they have similar efficacy, but there are sporadic (rare) reports of endophthalmitis (eye infections) with Avastin. Lucentis is safer, in this regard, because it comes in a single use vial.
With regards to side effects, there is no direct association between anti-VEGF drugs and atherothrombolic events ( like heart attacks and strokes), but Lucentis has less systemic absorption, so I would recommend this to my patients who had a recent history of stroke.
Eylea has recently been shown to have good results in diabetic macular edema, in terms of visual acuity, especially for those with worse vision to start with. This is a good option for those who don't respond well to Avastin or Lucentis.
Ozurdex is a completely different class of drug, a steroid implant. Its the only drug that lasts 3-4 months in the eye. Its long duration of action makes it ideal for diabetic patients who cant or wont tolerate repeated monthly injections for prolonged periods of time. It has been approved in the US and the Philippines for Retinal vein occlusions. It has been approved for use in diabetic macular edema in the USA. Its side effect is development of cataracts, and the intraocular pressure is monitored for elevation.
Since the cause of diabetic macular edema is multifactorial, it may well be that a combination of drugs may be needed to control the disease. This means that the physician may try anti-VEGF or Ozurdex first and then evaluate your response to therapy in subsequent visits. He may then switch or combine therapy. This disease was not developed overnight, so it may take many months or years to get the disease under control.
Surgery, as of now, is used when we have exhausted all treatment avenues. We may recommend it earlier if there are membranes in your eyes, which may be causing the edema.