Optical coherence tomography titrated photocoagulation in diabetic clinically significant macular edema
Clinically significant macular edema (CSME) is the commonest cause of legal blindness in diabetic patients. It is known to occur more often in adult onset diabetics . The Early Treatment of Diabetic Retinopathy Study (ETDRS) defines the CSME to have at least one of the three characteristics: (1) macular edema within 500μ of the center of fovea; (2) hard exudates within 500μ of the center of fovea with associated retinal edema; (3) retinal edema of one disc diameter, a part of which is within one disc diameter of the center of macula . The ETDRS has amply demonstrated that macular laser photocoagulation reduces macular edema, and thus stabilizes or improves the central visual acuity . In the ETDRS study the diagnosis of CSME was made on the basis of stereo fundus photographs and fluorescein angiography. The fluorescein angiography (FA) identified two forms of macular edema-focal and diffuse . Both types of macular edema respond to laser photocoagulation, though the focal edema respond better than diffuse edema . It has been opined that FA is not mandatory for diagnosis of CSME, and that stereoscopic evaluation by slit lamp biomicroscopy could be enough to treat and monitor the effect of treatment in many instances. However, it is known that the degree of macular edema, and not the amount of fluorescein dye leakage determines the extent of visual loss. Hence objective and reproducible measurement of macular edema could be an important determinant in management of CSME.
KeywordsOptical Coherence Tomography Macular Edema Diabetic Macular Edema Hard Exudate Retinal Edema
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