Paper

Current Treatment Approaches in Diabetic Macular Edema
Carsten H. Meyer

Department of Ophthalmology, Philipps University, Marburg, Germany

Address of Corresponding Author

Ophthalmologica 2007;221:118-131 (DOI: 10.1159/000098257)

  Key Words

• Diabetic macular edema
• Laser photocoagulation
• Pars plana vitrectomy
• Intravitreal injection

  Abstract

Purpose: To review current treatment approaches in diabetic macular edema (DME). Methods: 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. Results: 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. Conclusion: 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.

Copyright © 2007 S. Karger AG, Basel

  Author Contacts

Carsten H. Meyer, MD
Department of Ophthalmology, University of Bonn
Ernst-Abbe-Strasse 2, DE-53127 Bonn (Germany)
Tel. +49 228 287 15505, E-Mail meyer_eye@yahoo.com

  Article Information

Number of Print Pages : 14
Number of Figures : 13, Number of Tables : 1, Number of References : 105