Free previewYou're reading the free part of this topic. The rest is included with Clinical.See what's included
Diabetic macular oedema
Retina & Vitreous
Key Points
- •DME is the leading cause of visual impairment in diabetics; centre-involving DME with VA ≤20/25 requires intravitreal anti-VEGF as first-line (DRCR.net Protocol T: aflibercept superior for worse baseline VA)
- •OCT is the gold standard for diagnosis and monitoring; key biomarkers include CST, ellipsoid zone integrity, DRIL, and hyperreflective foci - these predict visual prognosis better than CST alone
- •Refractory DME (~30–40%) after anti-VEGF requires escalation: switch agent, add dexamethasone implant (Ozurdex) or fluocinolone acetonide implant (Iluvien); consider PPV if VMT present
- •Systemic optimisation is essential: HbA1c <7%, BP <130/80, fenofibrate 200 mg/day (FIELD/ACCORD Eye - reduces laser need by ~30%)
- •Protocol V: CI-DME with good VA (≥20/25) can be safely observed initially; ~34% require anti-VEGF by 2 years but no visual disadvantage to deferring treatment
Free preview ends here
Keep reading Diabetic macular oedema
16 more sections are included with the Clinical plan.
- Definition
- Epidemiology
- Aetiology and causes
- Pathogenesis
- Classification
- Clinical features