Current Treatment Approaches in Diabetic Macular Edema
- 1 March 2007
- journal article
- review article
- Published by S. Karger AG in Ophthalmologica
- Vol. 221 (2), 118-131
- https://doi.org/10.1159/000098257
Abstract
To review current treatment approaches in diabetic macular edema (DME). The underlying pathopathology, classifications and diagnostic examination techniques including fluorescein angiography, optical coherence tomography and stereoscopic biomicroscopy. Treatment modalities with focal or grid argon laser photocoagulation, pars plana vitrectomy with and without peeling of the inner limiting membrane (ILM), as well as intravitreal injections using triamcinolone acetonide or novel vascular endothelial growth factor (VEGF) inhibitors are described. DME results from a series of biochemical and cellular changes, causing progressive leakage and exudation. Focal and grid photocoagulation remains the standard care for diabetic maculopathy. However, the availability of new agents raises the possibility of improvements if significant benefits can be validated in randomized clinical trials. Posterior vitreous attachments play a critical role through several mechanical or physiological mechanisms. Vitrectomy without ILM removal seems to be effective in reducing the retinal thickness and improving visual acuity. A proper evaluation of the vitreous and retina is fundamental to select the most appropriate treatment approach in DME. While small microaneurysms with focal DME may be treated by conventional focal photocoagulation, diffuse DME which do not respond to grid photocoagulation may benefit from intravitreal injections using triamcinolone acetonide or novel VEGF inhibitors. Eyes with DME and additional vitreous traction may benefit from pars plana vitrectomy without ILM peeling. A combination of laser, pharmacological and surgical treatment modalities may be necessary to maintain central vision in eyes with DME.Keywords
This publication has 91 references indexed in Scilit:
- How Does Vitrectomy Affect Diabetic Macular Edema?American Journal of Ophthalmology, 2006
- Long-Term Outcome after Vitrectomy for Diabetic Macular EdemaOphthalmologica, 2006
- Vitrectomy for Diabetic Macular Edema with and without Internal Limiting Membrane RemovalOphthalmologica, 2006
- Vitrectomy for Persistent Diffuse Diabetic Macular EdemaAmerican Journal of Ophthalmology, 2005
- Posterior subtenon triamcinolone acetonide for refractory diabetic macular edemaAmerican Journal of Ophthalmology, 2005
- A Modified Technique to Stain the Internal Limiting Membrane with Indocyanine GreenOphthalmologica, 2004
- Surgical Management of Epiretinal Membrane with Indocyanine-Green-Assisted PeelingOphthalmologica, 2003
- Die diabetische Makulopathie - Klinik und TherapieKlinische Monatsblätter für Augenheilkunde, 2003
- Epidemiologie diabetischer Erblindungen - eine ÜbersichtKlinische Monatsblätter für Augenheilkunde, 2002
- Enzymatisch induzierte hintere Glaskörperabhebung bei proliferativer diabetischer VitreoretinopathieKlinische Monatsblätter für Augenheilkunde, 1999