Diabetic Macular Edema

About diabetic macular edema (DME)

Diabetic macular edema is a complication of diabetes. It occurs when fluid leaks into the macula (central part of the light-sensitive layer at the back of the eye). These leaks cause the macula to thicken and swell, progressively distorting acute vision: In some cases this can lead to a severe loss in central vision.

fundus showing patient with DME

Fundus photograph of left eye of 55-year-old diabetic and hypertensive gentleman with normal serum lipids showing abundant foveal hard exudates.

This image was originally published in the ASRS Retina Image Bank. Mallika Goyal. Apollo Health City, Hyderabad, India. Diabetic Macular Edema. Retina Image Bank. 2015; Image Number 1836. © the American Society of Retina Specialists.

Who does DME affect?

An estimated 30% of all patients suffering from diabetes for over 20 years are at risk of developing diabetic macular edema (DME)18.

Treating DME

The most common treatment option for DME is currently to use laser therapy, steroids, anti-vascular endothelial growth factor (VEGF) therapy or a combination of these treatments. A drug is injected inside the eye to try and limit the amount of fluid that accumulates inside the retina (light-sensitive layer at the back of the eye).

The problem is that these treatments often require repeated injections and have to be repeated several times a year. Some patients have to keep using the anti-VEGF injections for the rest of their lives, and unfortunately there are some indications that this prolonged use might cause other complications19. Undesirable side effects include partial loss of peripheral and night vision.

An alternative approach

Certain pharmacologic agents have the ability to liquefy the vitreous (pharmacologic vitreolysis) and induce a posterior vitreous detachment (PVD) in a statistically significant number of patients20. Randomized clinical trials are required to evaluate the clinical relevance of ocriplasmin for the treatment of DME.

 

References

18 Klein R, Klein B, Moss S, Davis M, DeMets D. The Wisconsin epidemiologic study of diabetic retinopathy. IV. Diabetic macular edema. Ophthalmology. 1984;91:1464-1474.
19 Ford KM, Saint-Geniez M, Walshe TE, D'Amore PA. Expression and role of VEGF--a in the ciliary body. Invest Ophthalmol Vis Sci. 2012 Nov 7;53(12):7520-7.
20 de Smet MD, Castilla M. Ocriplasmin for diabetic retinopathy. Expert Opin Biol Ther 2013;13(12):1741 7.