Diabetic Macular Edema (DME)

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.