Diabetic Macular Edema

Most frequent cause of decreased vision in patients with nonproliferative diabetes retinopathy. Clinical features: Symptoms: decreased vision May present as noncystoid or cystoid macular edema In noncystoid edema, the retina at the posterior pole appears thickened and fluorescein angiography demonstrates intraretinal leakage during the late phase In cystoid edema, diffuse retinal thickening at the foveal usually associated with microcysts and fluorescein angiography demonstrates flower-petal pattern of leakage at the fovea during the late phase Resorption of the edema commonly results in precipitation of lipid residues beneath the sensory retinal which can be observed as white to yellow deposits of hard exudates Management: Control diabetes, blood pressure and serum lipid profile. Focal laser photocoagulation in a clinically significant macular edema (CSDME). Consider vitrectomy if tractional component present or refractory to other treatment modalities. Follow-up 2-4 months after treatment of the macular edema, if persists, consider retreatment. Recent advance: consider intravitreal or subtenon corticosteroid injections in refractory cases.

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