eMedicine Specialties > Ophthalmology > Retina

Macular Edema, Diabetic: Follow-up

Author: Emmanouil Mavrikakis, MD, PhD, Consultant Vitreoretinal Surgeon, Ophthalmology Department, Athens Medical Centre, Greece
Coauthor(s): Wai-Ching Lam, MD, FRCS(C), Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto; Baseer U Khan, MD, Staff Physician, Department of Ophthalmology, University of Toronto, Canada
Contributor Information and Disclosures

Updated: Sep 29, 2009

Follow-up

Further Outpatient Care

  • Patients should be reassessed every 1-4 months depending on the severity of diabetic retinopathy.

Complications

  • Adverse effects and complications of laser use have been well documented and are beyond the scope of this article.
  • Subretinal fibrosis is a vision-threatening condition, which occurred in 2% of eyes with diabetic macular edema (DME) in the ETDRS.16
    • Subretinal fibrosis is an elevated mound or flat sheet of grey or white tissue deep to the retina at or near the center of the macula.
    • Fluorescein angiography appearance is hyperfluorescent in the capillary phase with persistence into the late phase and diffusion of dye.
    • This complication is associated most strongly with very severe hard exudates. It also is associated with a poor lipid profile. A previously proposed association with laser treatment has not been demonstrated in studies.
    • Poor prognosis exists; generally refractive to focal laser therapy.
  • Residual massive foveal hard exudates after the resolution of diabetic macular edema
  • Visual loss can be profound and irreversible. In one study, aspiration of hard exudates following a small retinotomy and serous neurosensory detachment demonstrated an increase of visual acuity in 5 of 7 patients.17

Prognosis

  • Untreated, 25-30% of patients with CSME exhibit a doubling of the visual angle within 3 years.
  • Treated, the risk drops by 50%.

Patient Education

  • Because patient lifestyle modification and compliance is essential in maintaining good health in the context of diabetes and cardiovascular health, it is imperative that patients understand that positive lifestyle modification can greatly reduce the development and progression of diabetic complication in the eye and other organs.
  • For excellent patient education resources, see eMedicine's Diabetes Center. Also, visit eMedicine's patient education article Diabetic Eye Disease.

Miscellaneous

Medicolegal Pitfalls

  • Medical/legal issues fall under the following 2 general categories:
 


More on Macular Edema, Diabetic

Overview: Macular Edema, Diabetic
Differential Diagnoses & Workup: Macular Edema, Diabetic
Treatment & Medication: Macular Edema, Diabetic
Follow-up: Macular Edema, Diabetic
References
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References

  1. Early Treatment Diabetic Retinopathy Study Research Group. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number 2. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. Jul 1987;94(7):761-74. [Medline].

  2. Albert DM, Jakobiec FA. Principles and Practice of Ophthalmology. 2nd ed. Philadelphia: WB Saunders Co; 2000.

  3. Aiello LP, Avery RL, Arrigg PG, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med. Dec 1 1994;331(22):1480-7. [Medline].

  4. Otani T, Kishi S, Maruyama Y. Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol. Jun 1999;127(6):688-93. [Medline].

  5. Chew EY, Klein ML, Ferris FL 3rd, et al. Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy. Early Treatment Diabetic Retinopathy Study (ETDRS) Report 22. Arch Ophthalmol. Sep 1996;114(9):1079-84. [Medline].

  6. Bonini-Filho MA, Jorge R, Barbosa JC, Calucci D, Cardillo JA, Costa RA. Intravitreal injection versus sub-Tenon's infusion of triamcinolone acetonide for refractory diabetic macular edema: a randomized clinical trial. Invest Ophthalmol Vis Sci. Oct 2005;46(10):3845-9. [Medline].

  7. Jonas JB, Martus P, Degenring RF, Kreissig I, Akkoyun I. Predictive factors for visual acuity after intravitreal triamcinolone treatment for diabetic macular edema. Arch Ophthalmol. Oct 2005;123(10):1338-43. [Medline].

  8. Patelli F, Fasolino G, Radice P, et al. Time course of changes in retinal thickness and visual acuity after intravitreal triamcinolone acetonide for diffuse diabetic macular edema with and without previous macular laser treatment. Retina. Oct-Nov 2005;25(7):840-5. [Medline].

  9. Avitabile T, Longo A, Reibaldi A. Intravitreal triamcinolone compared with macular laser grid photocoagulation for the treatment of cystoid macular edema. Am J Ophthalmol. Oct 2005;140(4):695-702. [Medline].

  10. Cunningham ET Jr, Adamis AP, Altaweel M, et al. A phase II randomized double-masked trial of pegaptanib, an anti-vascular endothelial growth factor aptamer, for diabetic macular edema. Ophthalmology. Oct 2005;112(10):1747-57. [Medline].

  11. Scott IU, Edwards AR, Beck RW, et al. A phase II randomized clinical trial of intravitreal bevacizumab for diabetic macular edema. Ophthalmology. Oct 2007;114(10):1860-7. [Medline].

  12. Hsu J. Drug delivery methods for posterior segment disease. Curr Opin Ophthalmol. May 2007;18(3):235-9. [Medline].

  13. Diabetic Retinopathy Clinical Research Network. A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology. Sep 2008;115(9):1447-9, 1449.e1-10. [Medline].

  14. Lewis H, Abrams GW, Blumenkranz MS, Campo RV. Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction. Ophthalmology. May 1992;99(5):753-9. [Medline].

  15. Tachi N, Ogino N. Vitrectomy for diffuse macular edema in cases of diabetic retinopathy. Am J Ophthalmol. Aug 1996;122(2):258-60. [Medline].

  16. Fong DS, Segal PP, Myers F, Ferris FL, Hubbard LD, Davis MD. Subretinal fibrosis in diabetic macular edema. ETDRS report 23. Early Treatment Diabetic Retinopathy Study Research Group. Arch Ophthalmol. Jul 1997;115(7):873-7. [Medline].

  17. Takagi H, Otani A, Kiryu J, Ogura Y. New surgical approach for removing massive foveal hard exudates in diabetic macular edema. Ophthalmology. Feb 1999;106(2):249-56; discussion 256-7. [Medline].

  18. Kertes. Clinical Trials in Ophthalmology: Summary and Practice Guide. Lippincott Williams & Wilkins; 1998:15-35.

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Further Reading

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Keywords

diabetic macular edema, DME, diabetes, diabetic eye disease, diabetic eye complications, diabetic retinopathy, DR, retinal edema, macula

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Contributor Information and Disclosures

Author

Emmanouil Mavrikakis, MD, PhD, Consultant Vitreoretinal Surgeon, Ophthalmology Department, Athens Medical Centre, Greece
Emmanouil Mavrikakis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Retina Specialists
Disclosure: Nothing to disclose.

Coauthor(s)

Wai-Ching Lam, MD, FRCS(C), Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto
Wai-Ching Lam, MD, FRCS(C) is a member of the following medical societies: American Academy of Ophthalmology, Canadian Ophthalmological Society, and Royal College of Physicians and Surgeons of Canada
Disclosure: Pfizer Grant/research funds Primary investigator; Novartis Honoraria Speaking and teaching; Novartis Honoraria Review panel membership

Baseer U Khan, MD, Staff Physician, Department of Ophthalmology, University of Toronto, Canada
Baseer U Khan, MD is a member of the following medical societies: Canadian Ophthalmological Society
Disclosure: Nothing to disclose.

Medical Editor

V Al Pakalnis, MD, PhD, Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center
V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians & Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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