Diabetic Macular Edema (DME)
- 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.
