Surgical treatment of diabetic macular edema

Abstract

Diabetic macular edema is the most common cause of visual impairment in diabetic patients. Precise pathophysiology of diabetic macular edema is unclear and seems to be multifactorial and includes pericyte loss, microaneurysm formation, basement membrane thickening and focal closure of the capillary bed, vitreomacular traction, and ultimately breakdown of the blood-retinal barrier with increased vascular permeability. Risk factors for clinical significant diabetic macular edema are hyperglycemia, hypertension, hyperlipidemia, duration of diabetes, and pregnancy. The increasing number of individuals with diabetes worldwide suggests that diabetic macular edema will continue to be major contributors to vision loss and associated functional impairment in the working-age population of most developed countries. Although eyes with diffuse macular edema carry a particularly poor prognosis despite laser photocoagulation, laser treatment is still the first choice of treatment for diabetic macular edema as it is safety and less invasive that other surgical options. Diffuse diabetic macular edema is characterized by diffuse leakage from extensive areas of the posterior retinal capillary bed, a scarcity of hard exudates, and often the formation of cystoid spaces. Focal macular edema, in contrast, is characterized by...