Vitreous & Retina

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Macular Diseases
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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