management of diabetic maculopathy

Last edited 12/2020 and last reviewed 09/2022

• focal maculopathy:
• photocoagulation is indicated if the visual acuity is better than 6/60
• vision worse than this usually indicates irreversible damage

• cystoid maculopathy:
• treatment is more difficult and less satisfactory than for focal maculopathy
• strict diabetic control may improve vision

• ischaemic maculopathy:
• there is no benefit from photocoagulation
• close monitoring for pre-proliferative retinopathy is essential

Management principles of diabetic macular oedema:

• glycaemic and blood pressure control (1)
• the most common treatment option for diabetic macular oedema is intravitreal injection of antiangiogenic, or anti-vascular endothelial growth
  factor (antiVEGF), drugs, which needs to be repeated over many years (2)
• other treatments for diabetic retinopathy and its complications, including diabetic macular oedema, are laser photocoagulation, intravitreal steroids, and vitrectomy

Notes:

• a systematic review concluded that (3):
• Intravitreal steroids may improve vision in people with DME compared to sham or control...Any benefits should be weighed against IOP elevation, the use of IOP-lowering medication and, in phakic patients, the progression of cataract. The need for glaucoma surgery is also increased, but remains rare.

Reference:

• Do DV et al. Blood pressure control for diabetic retinopathy. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No:
  CD006127. [DOI: 10.1002/14651858.CD006127.pub2]
• Virgil G et al. Anti-vascular endothelial growth factor for diabetic macular oedema: a network meta-analysis. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No: CD007419. [DOI: 10.1002/14651858.CD007419.pub5]
• Rittiphairoj T, Mir TA, Li T, Virgili G. Intravitreal steroids for macular edema in diabetes. Cochrane Database of Systematic Reviews 2020, Issue 11. Art. No.: CD005656. DOI: 10.1002/14651858.CD005656.pub3.