Atlas of Ophthalmology

Persisting Diabetic Macular Edema in Mild Non-proliferative Diabetic Retinopathy over Two Years (Fluorescence Angiography, SD-OCT, Colour Photography Posterior Segment)

Systemic Diseases -> Endocrine Disorders -> Diabetes Mellitus -> Retina -> Nonproliferative
Patient: 61 years of age, female, in 2014 BCVA 0,7 at OD, 0.9 at OS; in 2016; BCVA 0,8 at OD, 0.9 at OS. General Medical History: diabetes Type 2 since 30 years, Insulin therapy since 15 years, Hba1c 7,8%. Ocular Medical History: paracentral focal argon laser coagulation in 2014, antiVEFG injection in 2015. Purpose: to present persisting cystoid macular edema in mild non-proliferative diabetic retinopathy after paracentral focal argon laser coagulation and antiVEFG injection. Methods: Fluorescence Angiography in 2014 and 2016, SD-OCT in 2014 and 2016, Colour Photography Posterior Segment in 2014 and 2016. Findings: Colour Photography Posterior Segment in 2014: microaneurysms, hard exudates, macular thickening, signs of fresh focal argon laser coagulation, no retinal hemorrhages. Colour Photography Posterior Segment in 2016: less microaneurysms, no hard exudates, signs of focal argon laser coagulation, macular thickening, no retinal hemorrhages. Fluorescence Angiography in 2014: parafoveal leaking microaneurysms, central retinal capillary leakage. Fluorescence Angiography in 2016: parafoveal leaking microaneurysms, central retinal capillary leakage. SD-OCT in 2014: retinal thickening, parafoveal hard exsudates, cystoid spaces within 500 µm. SD-OCT in 2016: no parafoveal hard exsudates, decreasing cystoid spaces . Discussion: Diabetic macular edema (DME) is a leading cause of blindness in most industrialized nations. Diabetic macular edema is characterised by exudative fluid accumulation in the macula. It affects one in 15 people with diabetes resulting in more than 20 million cases worldwide. Pathogenesis of DME is related to the breakdown of the blood–retina barrier, leaking microaneurysms , upregulated cytokine, and other factors. Enhanced expression of the proangiogenic cytokine vascular endothelial growth factor (VEGF)-A has been validated in patients with DME. Hasegawa N et al. (1) demonstrated that the density of the microaneurysms in the deep capillary plexus (DCP) was significantly associated with the macular edema volume and that microaneurysms contributed to the pathogenesis of DME. Literature: (1) Hasegawa N, Nozaki M, Takase N, Yoshida M, Ogura Y. New Insights Into Microaneurysms in the Deep Capillary Plexus Detected by Optical Coherence Tomography Angiography in Diabetic Macular Edema. Invest Ophthalmol Vis Sci. 2016 Jul 1;57(9):OCT348-55.

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