The Macula pp 185-194 | Cite as

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 [1]. 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 [2]. The ETDRS has amply demonstrated that macular laser photocoagulation reduces macular edema, and thus stabilizes or improves the central visual acuity [3]. 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 [4]. Both types of macular edema respond to laser photocoagulation, though the focal edema respond better than diffuse edema [2]. 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.


Optical Coherence Tomography Macular Edema Diabetic Macular Edema Hard Exudate Retinal Edema 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Moss SE, Klein R, Klein BEK (1988) The incidence of vision loss in a diabetic population. Ophthalmology 95: 1340–8PubMedGoogle Scholar
  2. 2.
    Early Treatment Diabetic Retinopathy Study Research Group (1985) ETDRS report 1: Photocoagulation for diabetic macular edema. Arch Ophthalmol 103: 1796–1806CrossRefGoogle Scholar
  3. 3.
    Early Treatment Diabetic Retinopathy Study Research Group (1987) ETDRS Report: 4. Photo-coagulation for diabetic macular edema. Int Ophthalmol Clin 27: 254–64CrossRefGoogle Scholar
  4. 4.
    Bresnick GH (1983) Diabetic maculopathy: a critical review highlighting difuse macular edema. Ophthalmology 90: 1301–17PubMedGoogle Scholar
  5. 5.
    Puliafito CA, Hee MR, Schuman J, Fujimoto JG (1996) Optical coherence tomography of ocular diseases. Thorofare, Slack IncGoogle Scholar
  6. 6.
    Strom C, Sander B, Larsen N, Larsen M (2002) Diabetic macular edema assessed with optical coherence tomography and stereo fundus photography. Invest Ophthalmol Vis Sci 43: 241–5PubMedGoogle Scholar
  7. 7.
    Otani T, Kishi S, Maruyama Y (1999) Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol 127: 688–93PubMedCrossRefGoogle Scholar
  8. 8.
    Schaudig UH, Glaefke C, Scholz F, Richard G (2000) Optical coherence tomography for retinal thickness measurement in diabetic patients without clinically significant macular edema. Ophthalmic Surg Lasers 31: 182–6PubMedGoogle Scholar
  9. 9.
    Sanchez-Tocino H, Alvarez-Vidal A, Maldonado MJ, Moreno-Montanes M, Garcia-Layana A (2002) Retinal thickness study with optical coherence tomography in patients with diabetes. Invest Ophthalmol Vis Sci 43: 1588–94PubMedGoogle Scholar
  10. 10.
    Early Treatement Diabetic Retinopathy Study Group (1995) Focal photocoagulation treatment of diabetic macular edema: relationship of treatment effect top fluorescein angiographic and other retinal characteristics at baseline. ETDRS report No.19. Arch Ophthalmol 113: 1144–5CrossRefGoogle Scholar
  11. 11.
    Rivellese M, George A, Sulkes D, Reichel E, Puliafito C (2000) Optical coherence tomography after laser photocoagulation for clinically significant macular edema. Ophthalmol Surg Lasers 31: 192–7Google Scholar

Copyright information

© Springer-Verlag/Wien 2004

Authors and Affiliations

  1. 1.L V Prasad Eye InstituteHyderabadIndia

Personalised recommendations