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Diabetic Macular Edema

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Diabetic Retinopathy

Abstract

Diabetic retinopathy is the leading cause of blindness in persons under age 60 in the United States, and diabetic macular edema (DME) is the most common cause of visual loss in those with diabetic retinopathy.1–3 Natural history studies of eyes with DME show that 24% will lose at least three lines of vision over a period of 3 years.4 DME is increasing in prevalence throughout the world. In cross-sectional studies, the prevalence of DME in patients with diabetes has been reported to be 1.0–5.7%.5,6 The prevalence of DME in patients with diabetic retinopathy has been reported to be 2.7–11.0%.5,7–9 Suggestive data have been reported that the prevalence of DME relative to proliferative diabetic retinopathy (PDR) may vary by race with rates of DME relatively low in Native Americans relative to the rate of PDR.10 Besides its adverse effects on affected patients, DME is associated with large economic costs. In a Medicare claims study, diagnosis of DME was associated with a 34 and 33% increase in 1- and 3-year direct medical costs after adjustment for demographic variables and baseline comorbid conditions.11

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References

  1. Klein R, Klein B, Moss S, Cruickshanks K. The Wisconsin epidemiologic study of diabetic retinopathy: the long-term incidence of macular edema. Ophthalmology. 1995;102:7–16.

    CAS  PubMed  Google Scholar 

  2. Klein R, Klein BE, Moss SE, Linton KL. The Beaver Dam eye study. retinopathy in adults with newly discovered and previously diagnosed diabetes mellitus. Ophthalmology. 1992;99:58–62.

    CAS  PubMed  Google Scholar 

  3. Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy. A systematic review. JAMA. 2007;298:902–916.

    Article  CAS  PubMed  Google Scholar 

  4. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema. Arch Ophthalmol. 1985;103:1796–1806.

    Google Scholar 

  5. Xie XW, Xu L, Wang YX, Jonas JB. Prevalence and associated factors of diabetic retinopathy. The Beijing eye study 2006. Graefe's Arch Clin Exp Ophthalmol. 2008;246:1519–1526.

    Google Scholar 

  6. Wong TY, Cheung N, Tay WT, Wang JJ, Aung T, Saw SM, et al. Prevalence and risk factors for diabetic retinopathy. The Singapore Malay eye study. Ophthalmology. 2008;115:1869–75.

    Google Scholar 

  7. Rubino A, Rousculp MD, Davis K, Wang J, Girach A. Diagnosed diabetic retinopathy in France, Italy, Spain, and the United Kingdom. Prim Care Diabetes. 2007;1:75–80.

    Article  CAS  PubMed  Google Scholar 

  8. Wong TY, Klein R, Islam FMA, Cotch MF, Folsom AR, Klein BEK, et al. Diabetic retinopathy in a multi-ethnic cohort in the United States? Am J Ophthalmol. 2006;141:446–455.

    Article  PubMed  Google Scholar 

  9. Varma R, Torres M, Pena F, Klein R, Azen SP, Los Angeles Latino eye study group. Prevalence of diabetic retinopathy in adult latinos. Am Acad Ophthalmol. 2004;111:1298–1306.

    Google Scholar 

  10. Wolfe JA, Horton MB, McAteer MB, Szuter CF, Clayton T. Race, macular degeneration, and diabetic maculopathy. Arch Ophthalmol. 1993;111:1603–1604.

    CAS  PubMed  Google Scholar 

  11. Shea AM, Curtis LH, Hammill BG, Kowalski JW, Ravelo A, Lee PP, et al. Resource use and costs associated with diabetic macular edema in elderly persons. Arch Ophthalmol. 2008;126:1748–1754.

    Article  PubMed  Google Scholar 

  12. Klein BEK, Moss SE, Klein R, Surawicz TS. The Wisconsin epidemiologic study of diabetic retinopathy XIII. Relationship of serum cholesterol to retinopathy and hard exudate. Ophthalmology. 1991;98:1261–1265.

    CAS  PubMed  Google Scholar 

  13. Sigelman J. Diabetic macular edema in juvenile and adult onset diabetes. Am J Ophthalmol. 1980;90:287–296.

    CAS  PubMed  Google Scholar 

  14. Miljanovic B, Glynn RJ, Nathan DM, Manson JE, Schaumberg DA. A prospective study of serum lipids and risk of diabetic macular edema in type 1 diabetes. Diabetes. 2004;53:2883–2892.

    Article  CAS  PubMed  Google Scholar 

  15. Vitale S, Maguire MG, Murphy RP, Hiner CJ, Rourke L, Sackett C, et al. Clinically significant macular edema in type 1 diabetes incidence and risk factors. Ophthalmology. 1995;102:1170–1176.

    CAS  PubMed  Google Scholar 

  16. Klein R, Knudtson MD, Lee KE, Gangnon R, Klein BEK. The Wisconsin epidemiologic study of diabetic retinopathy XXIII. The twenty-five year incidence of macular edema in persons with type 1 diabetes. Ophthalmology. 2009;116:497–503.

    Article  PubMed  Google Scholar 

  17. Klein R, Klein BE, Moss SE, David MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy IV. Diabetic macular edema. Ophthalmology. 1984;91:1464–1474.

    CAS  PubMed  Google Scholar 

  18. Klein R, Klein BEK, Moss SE, Cruickshanks KJ. The 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes. Ophthalmology. 1998;105:1801–1815.

    Article  CAS  PubMed  Google Scholar 

  19. Lattanzio R, Brancato R, Pierro L, Bandello F, Iaccheri B, Fiore T, et al. Macular thickness measured by optical coherence tomography (OCT) in diabetic patients. Eur J Ophthalmol. 2002;12:482–487.

    CAS  PubMed  Google Scholar 

  20. Browning DJ, Fraser CM, Clark S. The relationship of macular thickness to clinically graded diabetic retinopathy severity in eyes without clinically detected diabetic macular edema. Ophthalmology. 2007;115:533–539.

    Article  PubMed  Google Scholar 

  21. Iwasaki M, Inomata H. Relation between superficial capillaries and foveal structures in the human retina. Invest Ophthalmol Vis Sci. 1986;27:1698–1705.

    CAS  PubMed  Google Scholar 

  22. Riva C, Petrig B. Blue field entoptic phenomenon and blood velocity in the retinal capillaries. Opt Soc Am. 1980;70:1234–1238.

    Article  CAS  Google Scholar 

  23. Henkind P. Symposium on glaucoma: joint meeting with the national society for the prevention of blindness: new observations on the radial peripapillary capillaries. Invest Ophthalmol Vis Sci. 1967;6:103–108.

    CAS  Google Scholar 

  24. Stefansson E. Ocular oxygenation and the treatment of diabetic retinopathy. Surv Ophthalmol. 2006;51:364–380.

    Article  PubMed  Google Scholar 

  25. Moore J, Bagley S, Ireland G, Mcleod D, Boulton ME. Three dimensional analysis of microaneurysms in the human diabetic retina. J Anat. 1999;194:89–100.

    Article  PubMed  Google Scholar 

  26. Tolentino MJ, McLeod DS, Taomoto M, Otsuji T, Adamis AP, Lutty GA. Pathologic features of vascular endothelial growth factor-induced retinopathy in the nonhuman primate. Am J Ophthalmol. 2002;133:373–385.

    Article  CAS  PubMed  Google Scholar 

  27. Sachdev N, Gupta V, Abhiramurthy V, Singh R, Gupta A. Correlation between microaneurysm closure rate and reduction in macular thickness following laser photocoagulation of diabetic macular edema. Eye. 2008;22:975–977.

    Article  CAS  PubMed  Google Scholar 

  28. Nishikawa H, Shahidi M, Vitale S, Alexander J, Asrani S, Mori M, et al. Relation between retinal thickening and clinically visible fundus pathologies in mild nonproliferative diabetic retinopathy. Ophthalmic Surg Lasers. 2002;33:127–134.

    Google Scholar 

  29. Blair NP, Shahidi M, Lai WW, Zelkha R. Correlation between microaneurysms and retinal thickness in diabetic macular edema. Retina. 2008;28:1097–1103.

    Article  PubMed  Google Scholar 

  30. DiabeticRetinopathy Clinical Research Network. Comparison of the modified early treatment diabetic retinopathy study and mild macular grid laser photocoagulation strategies for diabetic macular edema. Arch Ophthalmol. 2007;125:469–480.

    Article  Google Scholar 

  31. Nagaoka T, Kitaya N, Sugawara R, Yokota H, Mori F, Hikichi T, et al. Alteration of choroidal circulation in the foveal region in patients with type 2 diabetes. Br J Ophthalmol. 2004;88:1060–1063.

    Article  CAS  PubMed  Google Scholar 

  32. Fryczkowki AW, Hodes BL, Walker J. Diabetic choroidal and iris vasculature scanning electron microscopy findings. Int Ophthalmol. 1989;13:269–279.

    Article  Google Scholar 

  33. Quintyn JC, Brasseur G. Subretinal fluid in primary rhegmatogenous retinal detachment: physiopathology and composition. Surv Ophthalmol. 2004;49:96–108.

    Article  PubMed  Google Scholar 

  34. LaCour M. The retinal pigment epithelium. In: Kaufman PL, ed. Adle’s Physiology of the Eye: Clinical Application. St. Louis: Mosby; 2003:348–357.

    Google Scholar 

  35. Gardner TW, Antonetti DA, Barber AJ, LaNoue KF, Levison SW, Penn State Retina Research Group. Diabetic retinopathy: more than meets the eye. Surv Ophthalmol. 2002;47:S253–S262.

    Article  PubMed  Google Scholar 

  36. Qaum T, Xu Q, Joussen AM, Clemens MW, Qin W, Miyamoto K, et al. VEGF-initiated blood-retinal barrier breakdown in early diabetes. Invest Ophthalmol Vis Sci. 2001;42:2408–2413.

    CAS  PubMed  Google Scholar 

  37. Vinores SA, McGehee R, Lee A, Gadegbeku C, Campochiaro P. Ultrastructural localization of blood-retinal barrier breakdown in diabetic and galactosemic rats. J Histochem Cytochem. 1990;38:1341–1352.

    CAS  PubMed  Google Scholar 

  38. Tso M, Cunha-Vaz J, Shih C, Jones C. Clinicopathologic study of blood-retinal barrier in experimental diabetes mellitus. Arch Ophthalmol. 1980;98:2032–2040.

    CAS  PubMed  Google Scholar 

  39. Bringmann A, Uckermann O, Pannicke T, Iandiev I, Reichenbach A, Wiedemann P. Neuronal versus glial cell swelling in the ischemic retina. Acta Ophthalmol Scand. 2005;83:528–538.

    Article  PubMed  Google Scholar 

  40. Distler C, Dreher Z. Glia cells in the monkey retina-II. Muller cells. Vision Res. 1996;36:2381–2394.

    Article  CAS  PubMed  Google Scholar 

  41. Antcliff R J, Hussain AA, Marshall J. Hydraulic conductivity of fixed retinal tissue after sequential excimer laser ablation-barriers limiting fluid distribution and implications for cystoid macular edema. Arch Ophthalmol. 2001;119:539–544.

    CAS  PubMed  Google Scholar 

  42. Sebag J, Buckingham B, Charles A, Reiser K. Biochemical abnormalities in vitreous of humans with proliferative diabetic retinopathy. Arch Ophthalmol. 1992;110:1472–1476.

    CAS  PubMed  Google Scholar 

  43. Sebag J, Nie S, Reiser K, Charles MA, Yu NT. Raman spectroscopy of human vitreous in proliferative diabetic retinopathy? Invest Ophthalmol Vis Sci. 1994;35:2976–2980.

    CAS  PubMed  Google Scholar 

  44. Sebag J, Balazs EA. Pathogenesis of cystoid macular edema: consideration of vitreoretinal adhesions. Surv Ophthalmol. 1984;28:S493–S498.

    Article  Google Scholar 

  45. Holekamp NM, Shui YB, Beebe DC. Vitrectomy surgery increases oxygen exposure to the lens: a possible mechanism for nuclear cataract formation. Am J Ophthalmol. 2005;139:302–310.

    Article  PubMed  Google Scholar 

  46. LeGoff MM, Bishop PN. Adult vitreous structure and postnatal changes. Eye. 2008;22:1214–1222.

    Article  CAS  Google Scholar 

  47. Nasrallah FP, Jalkh AE, Coppenolle FV, Kado M, Trempe CL, McMeel JW, et al. The role of the vitreous in diabetic macular edema. Ophthalmology. 1988;95:1335–1339.

    CAS  PubMed  Google Scholar 

  48. Lewis H. The role of vitrectomy in the treatment of diabetic macular edema. Am J Ophthalmol. 2001;131:123–125.

    Article  CAS  PubMed  Google Scholar 

  49. Weinberger D, Fink-Cohen S, Gaton DD, Priel E, Yassur Y. Non-retinovascular leakage in diabetic maculopathy. Br J Ophthalmol. 1995;79:728–731.

    Article  CAS  PubMed  Google Scholar 

  50. Parving HH, Larsen M, Hommel E, Lund-Andersen H. Effect of antihypertensive treatment on blood-retinal barrier permeability to fluorescein in hypertensive Type 1 (insulin-dependent) diabetic patients with background retinopathy. Diabetologia. 1989;32:440–444.

    Article  CAS  PubMed  Google Scholar 

  51. Miyamoto K, Khosrof S, Bursell SE, Moromizato Y, Aiello LP, Ogura Y, et al. Vascular endothelial growth factor (VEGF)-induced retinal vascular permeability is mediated by intercellular adhesion molecule-1 (ICAM-1). Am J Pathol. 2000;156:1733–1739.

    CAS  PubMed  Google Scholar 

  52. Miyamoto K, Khosrof S, Bursell SE, Rohan R, Murata T, Clermont AC, et al. Prevention of leukostasis and vascular leakage in streptozotocin-induced diabetic retinopathy via intercellular adhesion molecule-1 inhibition. Proc Natl Acad Sci USA. 1999;96:10836–10841.

    Article  CAS  PubMed  Google Scholar 

  53. Sander B, Larsen M, Lund-Andersen H. Diabetic macular edema: passive and active transport of fluorescein through the blood-retina barrier. Invest Ophthalmol Vis Sci. 2001;42:433–438.

    CAS  PubMed  Google Scholar 

  54. Lund-Andersen H. Mechanisms for monitoring changes in retinal status following therapeutic intervention in diabetic retinopathy. Surv Ophthalmol. 2002;47:S270–S277.

    Article  PubMed  Google Scholar 

  55. SinclairSH, Grunwald JE, Riva CE, Braunstein SN, Nichols CW, Schwartz SS. Retinal vascular autoregulation in diabetes mellitus. Ophthalmology. 1982;89:748–750.

    Google Scholar 

  56. Harris A, Cuilla TA, Chung HK, Martin B. Regulation of retinal and optic nerve blood flow. Arch Ophthalmol. 1998;116:1491–1495.

    CAS  PubMed  Google Scholar 

  57. Clermont AC, Aiello LP, Mori F, Aiello LM, Bursell SE. Vascular endothelial growth factor and severity of nonproliferative diabetic retinopathy mediate retinal hemodynamics in vivo: a potential role for vascular endothelial growth factor in the progression of nonproliferative diabetic retinopathy. Am J Ophthalmol. 1997;124:433–446.

    CAS  PubMed  Google Scholar 

  58. Kristinsson JK, Gottfredsdottir MS, Stefansson E. Retinal vessel dilatation and elongation precedes diabetic macular oedema. Br J Ophthalmol. 1997;81:274–278.

    Article  CAS  PubMed  Google Scholar 

  59. Igersheimer J. Intraocular pressure and its relation to retinal extravasation. Arch Ophthalmol. 1944;32:50–55.

    Google Scholar 

  60. Amin RH, Frank RN, Kennedy A, Eliott D, Puklin JE, Abrams GW. Vascular endothelial growth factor is present in glial cells of the retina and optic nerve of humans with nonproliferative diabetic retinopathy. Invest Ophthalmol Vis Sci. 1997;38:36–47.

    CAS  PubMed  Google Scholar 

  61. Harba jNS, Felinski EA, Wolpert EB, Sundstrom JM, Gardner TW, Antonetti DA. VEGF activation of protein kinase C stimulates occludin phosphorylation and contributes to endothelial permeability. Invest Ophthalmol Vis Sci. 2006;47:5106–5115.

    Article  Google Scholar 

  62. Funatsu H, Yamashita H, Nakamura S, Mimura T, Eguchi S, Noma H, et al. Vitreous levels of pigment epithelium-derived factor and vascular endothelial growth factor are related to diabetic macular edema. Ophthalmology. 2006;113:294–301.

    Article  PubMed  Google Scholar 

  63. Joussen AM, Murata T, Tsujikawa A, Kirchhof B, Bursell SE, Adamis AP. Leukocyte-mediated endothelial cell injury and death in the diabetic retina. Am J Pathol. 2001;158:147–152.

    CAS  PubMed  Google Scholar 

  64. Kent D, Vinores SA, Campochiaro PA. Macular edema: the role of soluble mediators. Br J Ophthalmol. 2000;84:542–545.

    Article  CAS  PubMed  Google Scholar 

  65. Patel JI, Hykin PG, Cree IA. Diabetic cataract removal: postoperative progression of maculopathy-growth factor and clinical analysis. Br J Ophthalmol. 2006;90:697–701.

    Article  CAS  PubMed  Google Scholar 

  66. Gardner T, Eller A, Friberg T, D'Antonio J, Hollis T. Antihistamines reduce blood-retinal barrier permeability in type I (insulin-dependent) diabetic patients with nonproliferative retinopathy. Retina. 1995;15:134–140.

    Article  PubMed  Google Scholar 

  67. Kaiser PK. Antivascular endothelial growth factor agents and their development: therapeutic implications in ocular diseases? Am J Ophthalmol. 2006;142:660–668.

    Article  CAS  Google Scholar 

  68. Johnson MW. Etiology and treatment of macular edema. Am J Ophthalmol. 2009;147:11–21.

    Article  PubMed  Google Scholar 

  69. Cusick M, Chew EY, Chan CC, Kruth HS, Murphy RP, Ferris FL III. Histopathology and regression of retinal hard exudates in diabetic retinopathy after reduction of elevated serum lipid levels. Ophthalmology. 2003;110:2126–2133.

    Article  PubMed  Google Scholar 

  70. Hickam JB, Sieker HO. Retinal vascular reactivity in patients with diabetes mellitus with atherosclerosis. Circulation. 1960;22:243–246.

    CAS  PubMed  Google Scholar 

  71. Hickam JB, Frayser R. Studies of the retinal circulation in man. Observations on vessel diameter, arterio-venous oxygen difference, and mean circulation time. Circulation. 1966;33:302–316.

    Google Scholar 

  72. Patel JI, Saleh GM, Hykin PG, Gregor ZJ, Cree IA. Concentration of hemodynamic and inflammatory related cytokines in diabetic retinopathy. Eye. 2008;22:223–228.

    Article  CAS  PubMed  Google Scholar 

  73. Kaiser PK, Riemann CD, Sears JE, Lewis H. Macular traction detachment and diabetic macular edema associated with posterior hyaloidal traction. Am J Ophthalmol. 2001;131:44–49.

    Article  CAS  PubMed  Google Scholar 

  74. Otani T, Kishi S. A controlled study of vitrectomy for diabetic macular edema. Am J Ophthalmol. 2002;134:214–219.

    Article  PubMed  Google Scholar 

  75. Massin P, Duguid G, Erginay A, Haouchine B, Gaudric A. Optical coherence tomography for evaluating diabetic macular edema before and after vitrectomy. Am J Ophthalmol. 2003;135:169–177.

    Article  PubMed  Google Scholar 

  76. Kadonosono K, Itoh N, Ohno S. Perifoveal microcirculation before and after vitrectomy for diabetic cystoid macular edema. Am J Ophthalmol. 2000;130:740–744.

    Article  CAS  PubMed  Google Scholar 

  77. YuD Y, Cringle SJ, Su E, Yu PK, Humayun MS, Dorin G. Laser-induced changes in intraretinal oxygen distribution in pigmented rabbits. Invest Ophthalmol Vis Sci. 2005;46:988–999.

    Article  Google Scholar 

  78. Stefansson E, Landers M, Wolbarsht M. Increased retinal oxygen supply following pan-retinal photocoagulation and vitrectomy and lensectomy. Trans Am Ophthalmol Soc. 1981;129:308–321.

    Google Scholar 

  79. Browning DJ. Diabetic macular edema: a critical review of the early treatment diabetic retinopathy study (ETDRS) series and subsequent studies. Comp Ophthalmol Update 1. 2000;1:69–83.

    Google Scholar 

  80. Wallenten KG, Malmsjo M, Andreasson S, Wackenfors A, Johansson K, Ghosh F. Retinal function and PKC alpha expression after focal laser photocoagulation. Graefe's Arch Clin Exp Ophthalmol. 2007;245:1815–1824.

    Article  CAS  Google Scholar 

  81. Zhang X, Bao S, Lai D, Rapkins RW, Gillies MC. Intravitreal triamcinolone acetonide inhibits breakdown of the blood-retinal barrier through differential regulation of VEGF-A and its receptors in early diabetic rat retinas. Diabetes. 2008;57:1026–1033.

    Article  CAS  PubMed  Google Scholar 

  82. Gao H, Qiao X, Gao R, Mieler WF, McPherson AR, Holz ER. Intravitreal triamcinolone does not alter basal vascular endothelial growth factor mRNA expression in rat retina. Vision Res. 2004;44:349–356.

    Article  CAS  PubMed  Google Scholar 

  83. Nauck M, Karaliulakis G, Perruchoud AP, Papakonstantinou E, Roth M. Corticosteroids inhibit the expression of the vascular endothelial growth factor gene in human vascular smooth muscle cells. Eur J Pharmacol. 1998;341:309–315.

    Article  CAS  PubMed  Google Scholar 

  84. Tamura H, Miyamoto K, Kiryu J, Miyahara S, Katsuta H, Hirose F, et al. Intravitreal injection of corticosteroid attenuates leukostasis and vascular leakage in experimental diabetic retina. Invest Ophthalmol Vis Sci. 2005;46:1440–1444.

    Article  PubMed  Google Scholar 

  85. Cunningham MA, Edelman JL, Kaushal S. Intravitreal steroids for macular edema: the past, the present, and the future. Surv Ophthalmol. 2008;53:139–149.

    Article  PubMed  Google Scholar 

  86. Aiello LP, Clermont A, Arora V, Davis MD, Sheetz MJ, Bursell SE. Inhibition of PKC Beta by oral administration of ruboxistaurin is well tolerated and ameliorates diabetes-induced retinal hemodynamic abnormalities in patients. Invest Ophthalmol Vis Sci. 2006;47:86–92.

    Article  PubMed  Google Scholar 

  87. Gupta A, Gupta V, Thapar S, Bhansali A. Lipid-lowering drug atorvastatin as an adjunct in the management of diabetic macular edema. Am J Ophthalmol. 2004;137:675–682.

    CAS  PubMed  Google Scholar 

  88. Stefansson E, Landers MB. How does vitrectomy affect diabetic macular edema. Am J Ophthalmol. 2006;141:984–985.

    Article  PubMed  Google Scholar 

  89. Laidlaw DAH. Vitrectomy for diabetic macular edema? Eye. 2008;22:1337–1341.

    Article  CAS  PubMed  Google Scholar 

  90. Edelman JL, Lutz D, Castro MR. Corticosteroids inhibit VEGF-induced vascular leakage in a rabbit model of blood-retinal and blood-aqueous barrier breakdown. Exp Eye Res. 2005;80:249–258.

    Article  CAS  PubMed  Google Scholar 

  91. Dev S, Pulido JS, Tessler HH, Mittra RA, Han DP, Mieler WF, et al. Progression of diabetic retinopathy after endophthalmitis. Ophthalmology. 1999;106:774–781.

    Article  CAS  PubMed  Google Scholar 

  92. Reichenbach A, Wurm A, Pannicke T, Iandiev I, Wiedemann P, Bringmann A. Muller cells as players in retinal degeneration and edema? Graefe's Arch Clin Exp Ophthalmol. 2007;245:627–636.

    Article  Google Scholar 

  93. Lorenzi M. The polyol pathway as a mechanism for diabetic retinopathy: attractive, elusive, and resilient. Exp Diabetes Res. 2007.

    Google Scholar 

  94. Luan H, Roberts R, Sniegowski M, Goebel DJ, Berkowitz BA. Retinal thickness and subnormal retinal oxygenation response in experimental diabetic retinopathy. Invest Ophthalmol Vis Sci. 2006;47:320–328.

    Article  PubMed  Google Scholar 

  95. Moss SE, Klein R, Klein BEK. The 14-year incidence of visual loss in a diabetic population. Ophthalmology. 1998;105:998–1003.

    Article  CAS  PubMed  Google Scholar 

  96. Emanuele N, Klein R, Moritz T, Davis MD, Glander K, Anderson R, et al. Comparison of dilated fundus examinations with seven-field stereo fundus photographs in the Veterans Affairs Diabetes Trial. J Diabetes Complicat. 2009;23:323–9.

    Google Scholar 

  97. Early Treatment Diabetic Retinopathy Study Group. Grading diabetic retinopathy from stereoscopic color fundus photographs – an extension of the modified Airlie house classification, ETDRS Report No. 10. Ophthalmology. 1991;98:786–806.

    Google Scholar 

  98. Kiri A, Dyer DS, Bressler NM, Bressler SB, Schachat AP. Detection of diabetic macular edema: Nidek 3Dx stereophotography compared with fundus biomicroscopy. Am J Ophthalmol. 1996;122:654–662.

    CAS  PubMed  Google Scholar 

  99. Kinyoun J, Barton FB, Fishner MR, Hubbard LD, Aiello LP, Ferris FL, et al. Detection of diabetic macular edema: ophthalmoscopy versus photography-early treatment diabetic retinopathy study report number 5. Ophthalmology. 1989;96:746–751.

    Google Scholar 

  100. Krepler K, Wagner J, Sacu S, Wedrich A. The effect of intravitreal triamcinolone on diabetic macular edema. Graefe's Arch Clin Exp Ophthalmol. 2004;243:478–481.

    Article  Google Scholar 

  101. NegiA K, Vernon SA, Lim CS, Owen-Armstrong K. Intravitreal triamcinolone improves vision in eyes with chronic macular edema refractory to laser photocoagulation. Eye. 2005;19:747–751.

    Article  Google Scholar 

  102. Tunc M, Onder HI, Kaya M. Posterior sub-tenon's capsule triamcinolone injection combined with focal laser photocoagulation for diabetic macular edema. Ophthalmology. 2005;112:1086–1091.

    Article  PubMed  Google Scholar 

  103. Ciardella AP, Klancik J, Schiff W, Barile G, Langton K, Chang S. Intravitreal triamcinolone for the treatment of refractory diabetic macular edema with hard exudates: an optical coherence tomography study. Br J Ophthalmol. 2004;88:1131–1136.

    Article  CAS  PubMed  Google Scholar 

  104. Knudsen LL. Retrobulbar injection of methylprednisolone in diffuse diabetic macular edema. Retina. 2004;24:905–909.

    Article  PubMed  Google Scholar 

  105. Avci R, Kaderli B. Intravitreal triamcinolone injection for chronic diabetic macular edema with severe hard exudates. Graefe's Arch Clin Exp Ophthalmol. 2006;244:28–35.

    Article  CAS  Google Scholar 

  106. Jonas JB, Kreissig I, Sofker A, Degenring RF. Intravitreal injection of triamcinolone for diffuse diabetic macular edema. Arch Ophthalmol. 2003;121:57–61.

    Article  CAS  PubMed  Google Scholar 

  107. McDonald HR, Schatz H. Grid photocoagulation for diffuse macular edema. Retina. 1985;5:65–72.

    Article  CAS  PubMed  Google Scholar 

  108. Haritoglou C, Kook D, Neubauer A, WOlf A, Priglinger S, Strauss R, et al. Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema? Retina. 2006;26:999–1005.

    Article  PubMed  Google Scholar 

  109. Arevalo JF, Fromow-Guerra J, Quiroz-Mercado H, Sanchez JG, Wu L, Maia M, et al. Primary intravitreal bevacizumab (Avastin) for diabetic macular edema. Results from the Pan-American Collaborative Retina Study Group at 6-month follow-up. Ophthalmology. 2007;114:743–750.

    Article  Google Scholar 

  110. Bailey CC, Sparrow JM, Grey RHB, Cheng H. The national diabetic retinopathy laser treatment audit I. Maculopathy. Eye. 1998;12:69–76.

    PubMed  Google Scholar 

  111. Kumar A, Sinha S, Azad R, Sharma YR, Vohra R. Comparative evaluation of vitrectomy and dye-enhanced ILM peel with grid laser in diffuse diabetic macular edema. Graefe's Arch Clin Exp Ophthalmol. 2006;245:360–368.

    Article  Google Scholar 

  112. Abu El Asrar AM, Morse PH. Laser photocoagulation control of diabetic macular edema without fluorescein angiography. Br J Ophthalmol. 1991;75:97–99.

    Article  CAS  PubMed  Google Scholar 

  113. Aylward GW. Progressive changes in diabetics and their management. Eye. 2005;19:1115–1118.

    Article  CAS  PubMed  Google Scholar 

  114. Zein WM, Noureddin BN, Jurdi FA, Schakal A, Bashshur ZF. Panretinal photocoagulation and intravitreal triamcinolone acetonide for the management of proliferative diabetic retinopathy with macular edema. Retina. 2006;26:137–142.

    Article  PubMed  Google Scholar 

  115. Bresnick GH. Diabetic macular edema. A review? Ophthalmology. 1986;93:989–997.

    CAS  PubMed  Google Scholar 

  116. Gaucher D, Sebah C, Erinay A, Haouchine B, Tadayoni R, Gaudric A, et al. Optical coherence tomography features during the evolution of serous retinal detachment in patients with diabetic macular edema. Am J Ophthalmol. 2008;145:289–296.

    Article  PubMed  Google Scholar 

  117. Bardak Y, Cekic O, Tig SU. Comparison of ICG-assisted ILM peeling and triamcinolone-assisted posterior vitreous removal in diffuse diabetic macular oedema. Eye. 2006;20:1357–1359.

    Article  CAS  PubMed  Google Scholar 

  118. Zander E, Herfurth S, Bohl B, Heinke P, Herrmann U, Kohnert KD, et al. Maculopathy in patients with diabetes mellitus type 1 and type 2: associations with risk factors. Br J Ophthalmol. 2000;84:871–876.

    Article  CAS  PubMed  Google Scholar 

  119. Yamamoto S, Yamamoto T, Hayashi M, Takeuchi S. Morphological and functional analyses of diabetic macular edema by optical coherence tomography and multifocal electroretinograms. Graefe's Arch Clin Exp Ophthalmol. 2001;239:96–101.

    Article  CAS  Google Scholar 

  120. Velez-Montoya E, Fromow-Guerra J, Burgos O, Landers MB III, Morales-Caton V, Quiroz-Mercado H. The effect of unilateral intravitreal bevacizumab (Avastin) in the treatment of diffuse bilateral diabetic macular edema. A pilot study. Retina. 2009;29:20–26.

    Article  PubMed  Google Scholar 

  121. Kook D, Wolf A, Kreutzer T, Neubauer A, Strauss R, Ulbig M, et al. Long-term effect of intravitreal bevacizumab (Avastin) in patients with chronic diffuse diabetic macular edema. Retina. 2009;28:1053–1060.

    Article  Google Scholar 

  122. Verma LK, Vivek MB, Kumar A, Tewari HK, Venkatesh P. A prospective controlled trial to evaluate the adjunctive role of posterior sub-tenon triamcinolone in the treatment of diffuse diabetic macular edema. J Ocul Pharmacol Ther. 2004;20:277–284.

    Article  CAS  PubMed  Google Scholar 

  123. Lee SJ, Choi MG. Association of manganese superoxide dismutase gene polymorphism (V16A) with diabetic macular edema in Korean type 2 diabetic patients. Metabolism. 2006;55:1681–1688.

    Article  CAS  PubMed  Google Scholar 

  124. Berman DH, Friedman EA. Partial absorption of hard exudates in patients with diabetic end-stage renal disease and severe anemia after treatment with erythropoietin. Retina. 1994;14:1–5.

    CAS  PubMed  Google Scholar 

  125. Greenstein VC, Chen H, Hood DC, Holopigian K, Seiple W, Carr RE. Retinal function in diabetic macular edema after focal laser photocoagulation. Invest Ophthalmol Vis Sci. 2000;41:3655–3664.

    CAS  PubMed  Google Scholar 

  126. Greenstein VC, Holopigian K, Hood DC, Seiple W, Carr RE. The nature and extent of retinal dysfunction associated with diabetic macular edema. Invest Ophthalmol Vis Sci. 2000;41:3643–3654.

    CAS  PubMed  Google Scholar 

  127. Gaucher D, Tadayoni R, Erginay A, Haouchine B, Gaudric A, Massin P. Optical coherence tomography assessment of the vitreoretinal relationship in diabetic macular edema. Am J Ophthalmol. 2005;139:807–813.

    Article  PubMed  Google Scholar 

  128. Schatz H, Patz A. Cystoid maculopathy in diabetics? Arch Ophthalmol. 1976;94:761–768.

    Google Scholar 

  129. Jensen DB, Knudsen LL. Stereoscopic fluorescein angiography in diabetic maculopathy. Retina. 2006;26:153–158.

    Article  PubMed  Google Scholar 

  130. Gibran SK, Cullinane A, Jungkim S, Cleary PE. Intravitreal triamcinolone for diffuse diabetic macular edema. Eye. 2006;20:720–724.

    Article  CAS  PubMed  Google Scholar 

  131. Jeppesen P, Bek T. Impaired retinal autoregulation in small retinal arterioles before and after focal laser treatment for diabetic maculopathy. Br J Ophthalmol. 2006;90:198–201.

    Article  CAS  PubMed  Google Scholar 

  132. Catier A, Tadayoni R, Paques M, Erginay A, Haouchine B, Gaudric A, et al. Characterization of macular edema from various etiologies by optical coherence tomography. Am J Ophthalmol. 2005;140:200–206.

    PubMed  Google Scholar 

  133. Early Treatment Diabetic Retinopathy Study Group. Classification of diabetic retinopathy from fluorescein angiograms. ETDRS Report Number 11. Ophthalmology. 1991;98:807–822.

    Google Scholar 

  134. Early Treatment Diabetic Retinopathy Study Research Group. Focal photocoagulation treatment of diabetic macular edema-relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseline: ETDRS report number 19. Arch Ophthalmol. 1995;113:1144–1155.

    Google Scholar 

  135. Browning DJ, Fraser C. Regional patterns of sight-threatening diabetic macular edema. Am J Ophthalmol. 2005;140:117–124.

    Article  PubMed  Google Scholar 

  136. Browning DJ, Apte RS, Bressler SB, Chalam KV, Danis RP, Davis MD, et al. Association of the extent of diabetic macular edema as assessed by optical coherence tomography with visual acuity and retinal outcome variables. Retina. 2009;29:300–305.

    Article  PubMed  Google Scholar 

  137. Browning DJ, Altaweel MM, Bressler NM, Bressler SB, Scott IU, Diabetic Retinopathy Clinical Research Network. Diabetic macular edema: what is focal and what is diffuse. Am J Ophthalmol. 2008;146:649–655.

    Article  PubMed  Google Scholar 

  138. Lee CM, Olk RJ. Modified grid laser photocoagulation for diffuse diabetic macular edema long-term visual results. Ophthalmology. 1991;98:1594–1602.

    CAS  PubMed  Google Scholar 

  139. Hauser D, Bukelman A, Pokroy R, Katz H, Len A, Thein R, et al. Intravitreal triamcinolone for diabetic macular edema. Comparison of 1, 2 and 4 mg.? Retina. 2008;28:825–830.

    Article  PubMed  Google Scholar 

  140. Spandau UHM, Derse M, Schmitz-Valckenberg P, Papoulis C, Jonas J. Dosage dependency of intravitreal triamcinolone acetonide as treatment for diabetic macular edema. Br J Ophthalmol. 2005;89:999–1003.

    Article  CAS  PubMed  Google Scholar 

  141. Chieh JJ, Roth DB, Liu M, Belmone J, Nelson M, Regillo C, et al. Intravitreal triamcinolone acetonide for diabetic macular edema. Retina. 2005;25:828–834.

    Article  PubMed  Google Scholar 

  142. Martidis A, Duker JS, Greenberg PB, Rogers AH, Puliafito CA, Reichel E, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology. 2002;109:920–927.

    Article  PubMed  Google Scholar 

  143. Browning DJ, McOwen MD, Bowen RM Jr, O'Marah TL. Comparison of the clinical diagnosis of diabetic macular edema with diagnosis by optical coherence tomography. Ophthalmology. 2004;111:712–715.

    Article  PubMed  Google Scholar 

  144. Brown JC, Solomon SD, Bressler SB, Schachat AP, DiBernardo C, Bressler NM. Detection of diabetic foveal edema; contact lens biomicroscopy compared with optical coherence tomography. Arch Ophthalmol. 2004;122:330–335.

    Article  PubMed  Google Scholar 

  145. Browning DJ, Fraser CM. The predictive value of patient and eye characteristics on the course of subclinical diabetic macular edema? Am J Ophthalmol. 2008;145:149–154.

    Article  PubMed  Google Scholar 

  146. Patel JI, Hykin PG, Schadt M, Luong V, Fitzke F, Gregor ZJ. Pars plana vitrectomy for diabetic macular oedema: OCT and functional correlations. Eye. 2006;20:674–680.

    Article  CAS  PubMed  Google Scholar 

  147. Rosenblatt BJ, Shah GK, Sharma S, Bakal J. Pars plana vitrectomy with internal limiting membranectomy for refractory diabetic macular edema without a taut posterior hyaloid. Graefe's Arch Clin Exp Ophthalmol. 2005;243:20–25.

    Article  Google Scholar 

  148. Do DV, Shah SM, Sung JU, Haller JA, Nguyen QD. Persistent diabetic macular edema is associated with elevated hemoglobin A1c. Am J Ophthalmol. 2005;139:620–623.

    Article  CAS  PubMed  Google Scholar 

  149. Stolba U, Binder S, Gruber D, Krebs I, Aggermann T, Neumaier B. Vitrectomy for persistent diffuse diabetic macular edema. Am J Ophthalmol. 2005;140:295–301.

    Article  PubMed  Google Scholar 

  150. Massin P, Audren F, Haouchine B, Erginay A, Bergmann JF, Benosman R, et al. Intravitreal triamcinolone acetonide for diffuse diabetic macular edema; preliminary results of a prospective controlled trial. Ophthalmology. 2004;111:218–225.

    Article  PubMed  Google Scholar 

  151. Gangnon R, Hubbard LD, Aiello LM, Chew EY, Ferris FL, Fisher MR, et al. A severity scale for diabetic macular edema developed from ETDRS data. Invest Ophthalmol Vis Sci. 2008;49:5041–5047.

    Article  PubMed  Google Scholar 

  152. Davis MD, Sheetz MJ, Aiello LP, Milton RC, Danis RP, Zhi X, et al. Effect of ruboxistaurin on the visual acuity decline associated with longstanding diabetic macular edema. Invest Ophthalmol Vis Sci. 2009;50:1–4.

    Article  PubMed  Google Scholar 

  153. Recchia FM, Ruby AJ, Recchia CAC. Pars plana vitrectomy with removal of the internal limiting membrane in the treatment of persistent diabetic macular edema. Am J Ophthalmol. 2005;139:447–454.

    Article  PubMed  Google Scholar 

  154. Brun SC, Bressler SB, Maguire MG. A comparison of fundus biomicroscopy and 90 diopter lens examination in the detection of diabetic macular edema. Invest Ophthalmol Vis Sci. 1993;34:72.

    Google Scholar 

  155. Rudniskey CJ, Tennant MTS, de Leon AP, Hinz BJ, Greve MDJ. Benefits of stereopsis when identifying clinically significant macular edema via teleophthalmology. Can J Ophthalmol. 2006;41:727–732.

    Article  Google Scholar 

  156. Bresnick GH, Mukamel DB, Dickinson JC, Cole DR. A screening approach to the surveillance of patients with diabetes for the presence of vision-threatening retinopathy. Ophthalmology. 2000;107:19–24.

    Article  CAS  PubMed  Google Scholar 

  157. Davis MD, Bressler SB, Aiello LP, Bressler NM, Browning DJ, Flaxel CJ, et al. Comparison of time-domain OCT and fundus photographic assessments of retinal thickening in eyes with diabetic macular edema. Invest Ophthalmol Vis Sci. 2008;49:1745–1752.

    Article  PubMed  Google Scholar 

  158. Sander B, Hamann P, Larsen M. A 5-year follow-up of photocoagulation in diabetic macular edema: the prognostic value of vascular leakage for visual loss. Graefe's Arch Clin Exp Ophthalmol. 2008;246:1535–1539.

    Article  CAS  Google Scholar 

  159. Sander B, Thornit DN, Colmorn L, Strom C, Girach A, Hubbard LD, et al. Progression of diabetic macular edema: correlation with blood-retinal barrier permeability, retinal thickness, and retinal vessel diameter. Invest Ophthalmol Vis Sci. 2007;48:3983–3987.

    Article  PubMed  Google Scholar 

  160. Chew EY, Benson WR, Boldt HC, Chang TS, Lobes LA, Miller JW, et al. Diabetic retinopathy preferred practice guidelines. San Franciso: American Academy of Ophthalmology; 2003.

    Google Scholar 

  161. Browning DJ, Elmore C. Is the outcome of focal photocoagulation for diabetic macular edema influenced by using preoperative fluorescein angiography(FA). (Abstract). American Academy of Ophthalmology Annual Meeting. 1998.

    Google Scholar 

  162. Kylstra JA, Brown JC, Jaffe GJ, Cox TA, Gallenmore R, Greven CM, et al. The importance of fluorescein angiography in planning laser treatment of diabetic macular edema. Ophthalmology. 1999;106:2068–2073.

    Article  CAS  PubMed  Google Scholar 

  163. Diabetic Retinopathy Clinical Research Network, Scott IU, Edwards AR, Beck RW, Bressler NM, Chan CK, et al. A phase II randomized clinical trial of intravitreal bevacizumab for diabetic macular edema? Ophthalmology. 2007;114:1860–1867.

    Google Scholar 

  164. Razvi FM, Kritzinger EE, Tsaloumas MD, Ryder REJ. Use of fluorescein angiography in the diagnosis of diabetic macular edema within a diabetic retinopathy screening program. Diabetes Med. 2001;18:1003–1006.

    Article  CAS  Google Scholar 

  165. Massin P, Girach A, Erginay A, Gaudric A. Optical coherence tomography: a key to the future management of patients with diabetic macular edema. Acta Ophthalmol Scand. 2006;84:466–474.

    Article  PubMed  Google Scholar 

  166. Lee P, Blumberg DM. Understanding the critical importance of diagnosis in the measurement of quality of care. Arch Ophthalmol. 2008;126:426–427.

    Article  PubMed  Google Scholar 

  167. Bressler NM, Edwards AR, Antoszyk AN, Beck RW, Browning DJ, Ciardella AP, et al. Retinal thickness on stratus optical coherence tomography in people with diabetes and minimal or no diabetic retinopathy. Am J Ophthalmol. 2008;145:894–901.

    Article  PubMed  Google Scholar 

  168. Browning DJ. Interobserver variability in optical coherence tomography for macular edema. Am J Ophthalmol. 2004;137:1116–1117.

    Article  PubMed  Google Scholar 

  169. Browning DJ, Fraser CM. Intraobserver variability in optical coherence tomography. Am J Ophthalmol. 2004;138:477–479.

    Article  PubMed  Google Scholar 

  170. Diabetic Retinopathy Clinical Research Network. Reproducibility of macular thickness and volume using Zeiss optical coherence tomography in patients with diabetic macular edema. Ophthalmology. 2007;114:1520–1525.

    Article  Google Scholar 

  171. Massin P, Viaut E, Haouchine B, Erginay A, Paques M, Gaudric A. Reproducibility of retinal mapping using optical coherence tomography. Arch Ophthalmol. 2001;119:1135–1142.

    CAS  PubMed  Google Scholar 

  172. Koozekanani D, Roberts C, Katz SE, Herderick EE. Intersession repeatability of macular thickness measurements with the Humphrey 2000 OCT. Invest Ophthalmol Vis Sci. 2000;41:1486–1491.

    CAS  PubMed  Google Scholar 

  173. Browning DJ, Fraser C, Propst BW. The variation in optical coherence tomography-measured macular thickness in diabetic eyes without clinical macular edema. Am J Ophthalmol. 2008;145:889–893.

    Article  PubMed  Google Scholar 

  174. Toda J, Fukushima H, Kato S. Injection of triamcinolone acetonide into the posterior sub-tenon capsule for treatment of diabetic macular edema.? Retina. 2007;27:764–769.

    Article  PubMed  Google Scholar 

  175. Striph GG, Hart WM, Olk RJ. Modified grid laser photocoagulation for diabetic macular edema-the effect on the central visual field. Ophthalmology. 1988;95:1673–1679.

    CAS  PubMed  Google Scholar 

  176. Browning DJ, Glassman AR, Aiello LP, Bressler NM, Bressler S, Danis RP, et al. Optical coherence tomography measurements and analysis methods in optical coherence tomography studies of diabetic macular edema. Ophthalmology. 2008;115:1366–1371.

    Article  PubMed  Google Scholar 

  177. Chan A, Duker JS. A standardized method for reporting changes in macular thickening using optical coherence tomography. Arch Ophthalmol. 2005;123:939–943.

    Article  PubMed  Google Scholar 

  178. Otani T, Kishi S, Maruyama Y. Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol. 1999;127:68–693.

    Article  Google Scholar 

  179. Kang SW, Park CY, Ham DI. The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular edema. Am J Ophthalmol. 2004;137:313–322.

    Article  PubMed  Google Scholar 

  180. Ozdek SC, Erdinc MA, Gurelik G, Aydin B, Bahceci U, Hasanreisoglu B. Optical coherence tomographic assessment of diabetic macular edema: comparison with fluorescein angiographic and clinical findings. Ophthalmologica. 2004;219:86–92.

    Google Scholar 

  181. Diabetic Retinopathy Clinical Research Network. Diurnal variation in retinal thickening measurement by optical coherence tomography in center-involved diabetic macular edema. Arch Ophthalmol. 2006;124:1701–1707.

    Article  Google Scholar 

  182. Hee MR, Puliafito CA, Wong C, Duker JS, Reichel E, Rutledge B, et al. Quantitative assessment of macular edema with optical coherence tomography. Arch Ophthalmol. 1995;113:1019–1029.

    CAS  PubMed  Google Scholar 

  183. Forooghian F, Cukras C, Meyerle CB, Chew EY, Wong WT. Evaluation of time domain and spectral domain optical coherence tomography in the measurement of diabetic macular edema. Invest Ophthalmol Vis Sci. 2008;49:4290–4296.

    Article  PubMed  Google Scholar 

  184. Kakinoki M, Sawada O, Sawada T, Kawamura H, Ohji M. Comparison of macular thickness between Cirrus HD-OCT and Stratus OCT. Ophthalmic Surg Lasers Imaging. 2008;39:S37–S42.

    Google Scholar 

  185. Legaretta JE, Gregori G, Punjabi OS, Knighton RW, Lalwani GA, Puliafito CA. Macular thickness measurements in normal eyes using spectral domain optical coherence tomography? Ophthalmic Surg Lasers Imaging. 2008;39:S43-S49.

    Google Scholar 

  186. Drexler W. Cellular and functional optical coherence tomography of the human retina? Invest Ophthalmol Vis Sci. 2007;48:5340.

    Article  Google Scholar 

  187. Menke MN, Dabov S, Knecht P, Sturm V. Reproducibility of retinal thickness measurements in healthy subjects using spectralis optical coherence tomography. Am J Ophthalmol. 2009;147:467–472.

    Article  PubMed  Google Scholar 

  188. Brasil OFM, Smith SD, Galor A, Lowder CY, Sears JE, Kaiser PK. Predictive factors for short-term visual outcome after intravitreal triamcinolone acetonide injection for diabetic macular edema: an optical coherence tomography study. Br J Ophthalmol. 2006;91:761–765.

    Article  Google Scholar 

  189. Diabetic Retinopathy Clinical Research Network. Relationship between optical coherence tomography–measured central retinal thickness and visual acuity in diabetic macular edema. Ophthalmology. 2007;114:525–536.

    Article  Google Scholar 

  190. Browning DJ, Fraser CM, Powers ME. A spreadsheet template for the analysis of optical coherence tomography in the longitudinal management of diabetic macular edema. Ophthalmic Surg Lasers Imaging. 2006;37:399–405.

    PubMed  Google Scholar 

  191. Otani T, Kishi S. Correlation between optical coherence tomography and fluorescein angiography findings in diabetic macular edema. Ophthalmology. 2007;114:104–107.

    Article  PubMed  Google Scholar 

  192. Sander B, Larsen M, Engler C, Moldow B, Larsen N, Lund. Diabetic macular edema: a comparison of vitreous fluorometry, angiography, and retinopathy. Br J Ophthalmol. 2002;86:316–320.

    Article  CAS  PubMed  Google Scholar 

  193. Bungay PM, Roy MS, Bonner RF. Posterior vitreous fluorophotometry. I. Description of a new analysis procedure and results in normal subjects. Arch Ophthalmol. 1989;107:1321–1327.

    CAS  PubMed  Google Scholar 

  194. Larsen M, Hommel E, Parving HH, Lund-Andersen H. Protective effect of captopril on the blood-retina barrier in normotensive insulin-dependent diabetic patients with nephropathy and background retinopathy. Graefe's Arch Clin Exp Ophthalmol. 1990;228:505–509.

    Article  CAS  Google Scholar 

  195. Grenda P, Lupo S, Domanico D, Vingolo EM. Efficacy of intravitreal triamcinolone acetonide in long standing diabetic macular edema. A microperimetry and optical coherence tomography study. Retina. 2008;28:1270–1275.

    Article  Google Scholar 

  196. Vujosevic S, Midena E, Pilotto E, Radin PP, Chiesa L, Cavarzeran F. Diabetic macular edema: correlation between microperimetry and optical coherence tomography findings. Invest Ophthalmol Vis Sci. 2006;47:3044–3051.

    Article  PubMed  Google Scholar 

  197. Fong D, Segal P, Myers F, Ferris F, Hubbard L, Davis M. Subretinal fibrosis in diabetic macular edema.? Arch Ophthalmol. 1997;115:873–877.

    CAS  PubMed  Google Scholar 

  198. Diabetes Control and Complications Trial Research Group. Progression of retinopathy with intensive versus conventional treatment in the diabetes control and complications trial. Ophthalmology. 1995;102:647–661.

    Google Scholar 

  199. Diabetes Control and Complications Trial Research Group. Early worsening of diabetic retinopathy in the diabetes control and complications trial. Arch Ophthalmol. 1998;116:874–886.

    Google Scholar 

  200. The writing team for the diabetes control and complications trial/Epidemiology of diabetes interventions and complications research group. Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA. 2002;287:2563–2569.

    Article  Google Scholar 

  201. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–853.

    Article  Google Scholar 

  202. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317:703–714.

    Google Scholar 

  203. Engler CB, Parving HH, Methiesen ER, Larsen M, Lund-Andersen H. Blood-retina barrier permeability in diabetes during acute ACE-inhibition. Acta Ophthalmol. 1991;69:581–585.

    CAS  Google Scholar 

  204. Chowdhury TA, Hopkins D, Dodson PM, Vafidis GC. The role of serum lipids in exudative diabetic maculopathy: is there a place for lipid lowering therapy. Eye. 2002;16:689–693.

    Article  CAS  PubMed  Google Scholar 

  205. Chew EY, Klein ML, Ferris FL, Remaley NA, Murphy RP, Chantry K, et al. Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy-early treatment diabetic retinopathy study (ETDRS) report 22. Arch Ophthalmol. 1996;114:1079–1084.

    Google Scholar 

  206. Kremser BG, Falk M, Kieselbach GF. Influence of serum lipid fractions on the course of diabetic macular edema after photocoagulation? Ophthalmologica. 1995;209:60–63.

    Article  CAS  PubMed  Google Scholar 

  207. Gordon B, Chang S, Kavanagh M, Berrocal M, Yannuzzi L, Robertson C, et al. The effects of lipid lowering on diabetic retinopathy? Am J Ophthalmol. 1991;112:385–391.

    CAS  PubMed  Google Scholar 

  208. Harrold BP, Marmion VJ, Gough KR. A double -blind controlled trial of clofibrate in the treatment of diabetic retinopathy. Diabetes. 1969;18:285–291.

    CAS  PubMed  Google Scholar 

  209. Duncan LJP, Cullen JF, Ireland JF, Nolan J, Clarke BF, Oliver MF. A three-year trial of Atromid therapy in exudative diabetic retinopathy. Diabetes. 1968;17:467.

    Google Scholar 

  210. Perkovich BT, Meyers SM. Systemic factors affecting diabetic macular edema. Am J Ophthalmol. 1988;105:211–212.

    CAS  PubMed  Google Scholar 

  211. Ramsay RC, Knobloch WH, Barbosa JJ, Sutherland DE, Kjellstrand CM, Najarain JS, et al. The visual status of diabetic patients after renal transplantation. Am J Ophthalmol. 1979;87:305–310.

    CAS  PubMed  Google Scholar 

  212. Ciardella AP. Partial resolution of diabetic macular edema after systemic treatment with furosemide. Br J Ophthalmol. 2004;88:1224–1225.

    Article  CAS  PubMed  Google Scholar 

  213. Emoto M, Sato AT, Tanabe K, Tanizawa Y, Matsutani A, Oka Y. Troglitazone treatment increases plasma vascular endothelial growth factor in diabetic patients and its mRNA in 3T3-L1 adipocytes. Diabetes. 2001;50:1166–1170.

    Article  CAS  PubMed  Google Scholar 

  214. Liazos E, Broadbent DM, Beare N, Kumar N. Spontaneous resolution of diabetic macular oedema after discontinuation of thiazolidenediones. Diabet Med. 2008;25:860–882.

    Article  CAS  PubMed  Google Scholar 

  215. Colucciello M. Vision loss due to macular edema induced by rosiglitazone treatment of diabetes mellitus. Arch Ophthalmol. 2005;123:1273–1275.

    Article  PubMed  Google Scholar 

  216. Ryan EH, Han DP, Ramsay RC, Cantrill HL, Bennett SR, Dev S, et al. Diabetic macular edema associated with glitazone use. Retina. 2006;26:562–570.

    Article  PubMed  Google Scholar 

  217. Aiello LP, Bursell SE, Clermont A, Duh E, Ishii H, Takagi C, et al. Vascular endothelial growth factor-induced retinal permeability is mediated by protein kinase C in vivo and suppressed by an orally effective B-isoform-selective inhibitor. Diabetes. 1997;46:1473–1480.

    Article  CAS  PubMed  Google Scholar 

  218. PKC-DRS2 Group. Effect of Ruboxistaurin on visual loss in patients with diabetic retinopathy. Ophthalmology. 2006;113:2221–2230.

    Article  Google Scholar 

  219. The PKC-DMES Study Group. Effect of ruboxistaurin in patients with diabetic macular edema. Thirty-month results of the randomized PKC-DMES clinical trial. Arch Ophthalmol. 2007;125:318–324.

    Article  Google Scholar 

  220. Singh R, Abhiramamurthy V, Gupta V, Gupta A, Bhansali A. Effect of multifactorial intervention on diabetic macular edem. Diabetes Care. 2006;29:463–464.

    Article  PubMed  Google Scholar 

  221. Wang Q, Klein R, Moss SE, Klein BEK, Hoyer C, Burke K, et al. The influence of combined kidney-pancreas transplantation on the progression of diabetic retinopathy; a case series. Ophthalmology. 1994;101:1071–1076.

    CAS  PubMed  Google Scholar 

  222. Early Treatment Diabetic Retinopathy Study Research Group. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema-Early treatment diabetic retinopathy study report number 2. Ophthalmology. 1987;94:761–774.

    Google Scholar 

  223. Roider J, Brinkmann R, Wirbelauer C, Laqua H, Birngruber R. Subthreshold (retinal pigment epithelium) photocoagulation in macular diseases: a pilot study. Br J Ophthalmol. 2000;84:40–47.

    Article  CAS  PubMed  Google Scholar 

  224. Browning DJ, Zhang Z, Benfield JM. The effect of patient characteristics on response to focal laser treatment for diabetic macular edema. Ophthalmology. 1997;104:466–472.

    CAS  PubMed  Google Scholar 

  225. Gupta A, Gupta V, Dogra MR, Pandav SS. Risk factors influencing the treatment outcome in diabetic macular oedema. Ind J Ophthalmol. 1996;44:145–148.

    CAS  Google Scholar 

  226. Shimonagano Y, Makiuchi R, Miyazaki M, Doi N, Uemura A, Sakamoto T. Results of visual acuity and foveal thickness in diabetic macular edema after vitrectomy. Jpn J Ophthalmol. 2007;51:204–209.

    Article  PubMed  Google Scholar 

  227. Diabetic Retinopathy Clinical Research Network. A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology. 2008;1447–1459.

    Google Scholar 

  228. Aiello LM. Perspectives on diabetic retinopathy. Am J Ophthalmol. 2003;136:122–135.

    Article  Google Scholar 

  229. Patel JI, Hykin PG, Schadt M, Luong V, Bunce C, Fitzke F, et al. Diabetic macular oedema: pilot randomised trial of parts plana vitrectom. vs. macular argon photocoagulation? Eye. 2006;20:873–881.

    Article  CAS  PubMed  Google Scholar 

  230. Schatz H, Madeira D, McDonald R, Johnson R. Progressive enlargement of laser scars following grid laser photocoagulation for diffuse diabetic macular edema. Arch Ophthalmol. 1991;109:1549–1551.

    Google Scholar 

  231. Framme C, Roider J. Immediate and long-term changes of fundus autofluorescence in continuous wave laser lesions of the retina. Ophthalmic Surg Lasers Imaging. 2004;35:131–138.

    PubMed  Google Scholar 

  232. Guyer DR, D'Amico DJ, Smith CW. Subretinal fibrosis after laser photocoagulation for diabetic macular edema. Am J Ophthalmol. 1992;113:652–656.

    CAS  PubMed  Google Scholar 

  233. Han DP, Mieler WF, Burton TC. Submacular fibrosis after photocoagulation for diabetic macular edema. Am J Ophthalmol. 1992;113:513–521.

    CAS  PubMed  Google Scholar 

  234. Lewis H, Schachat AP, Haimann MH, Haller JA, Quinlan P, Von Fricken MA, et al. Choroidal neovascularization after laser photocoagulation for diabetic macular edema. Ophthalmology. 1990;97:503–511.

    CAS  PubMed  Google Scholar 

  235. Ip MS, Edwards AR, Beck RW, Bressler NM. Author reply. Ophthalmology. 2009;116:596–507.

    Google Scholar 

  236. Kim JE, Pollack JS, Miller DG, Mittra RA, Spaide RF, ISIS Study Group. ISIS-DME. A prospective, randomized, dose-escalation intravitreal steroid injection study for refractory diabetic macular edema. Retina. 2008;28:735–740.

    Article  PubMed  Google Scholar 

  237. Thomas D, Bunce C, Moorman C, Laidlaw DAH. A randomized controlled feasibility trial of vitrectomy versus laser for diabetic macular edema? Br J Ophthalmol. 2005;89:81–86.

    Article  CAS  PubMed  Google Scholar 

  238. Pendergast SD, Hassan TS, Williams GA, Cox MS, Margherio RR, Ferrone PJ, et al. Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid. Am J Ophthalmol. 2000;130:178–186.

    Article  CAS  PubMed  Google Scholar 

  239. Blumenkranz MS, Yellachich D, Andersen DE, Wiltberger MW, Mordaunt D, Marcellino GR, et al. Semiautomated patterned scanning laser for retinal photocoagulation. Retina. 2006;26:370–376.

    Article  PubMed  Google Scholar 

  240. Browning DJ, Antoszyk AN. The effect of the surgeon and the laser wavelength on the response to focal photocoagulation for diabetic macular edema. Ophthalmology. 1999;106:243–248.

    Article  CAS  PubMed  Google Scholar 

  241. Browning DJ, Fraser CM, Powers ME. Comparison of the magnitude and time course of macular thinning induced by different interventions for diabetic macular edema: implications for sequence of application. Ophthalmology. 2006;113:1713–1719.

    Article  PubMed  Google Scholar 

  242. Diabetic Retinopathy Clinical Research Network. Randomized trial of peribulbar triamcinolone acetonide with and without focal photocoagulation for mild diabetic macular edema. A pilot study. Ophthalmology. 2007;114:1190–1196.

    Article  Google Scholar 

  243. King RC, Dobree JH, Kok DA, Foulds WS, Dangerfield WG. Exudative diabetic retinopathy. Spontaneous changes and effects of a corn oil diet. Br J Ophthalmol. 1963;47:666–672.

    Article  CAS  PubMed  Google Scholar 

  244. Joussen AM, Weiss C, Bauer D, Hilgers RD, the TIME Study Group. Triamcinolone versus inner-limiting membrane peeling in persistent diabetic macular edema (TIME study): design issues and implications. Graefe's Arch Clin Exp Ophthalmol. 2007;245:1781–1787.

    Article  Google Scholar 

  245. Dehghan MH, Ahmadieh H, Ramezani A, Entezari M, Anisian A. A randomized, placebo-controlled clinical trial of intravitreal triamcinolone for refractory diabetic macular edema? Int Ophthalmol. 2008;28:7–17.

    Article  PubMed  Google Scholar 

  246. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation therapy for diabetic eye disease. JAMA. 1985;254:3086.

    Article  Google Scholar 

  247. Khairallah M, Brahim R, Allagui M, Chachia N. Comparative effects of argon green and krypton red laser photocoagulation for patients with diabetic exudative maculopathy. Br J Ophthalmol. 1996;80:319–322.

    Article  CAS  PubMed  Google Scholar 

  248. Olk RJ, Wallow IH, Poulsen GL. Argon green (514 nm) versus krypton red (647 nm) modified grid laser photocoagulation for diffuse diabetic macular edema. Ophthalmology. 1990;1101–1112.

    Google Scholar 

  249. Smiddy WE, Fine SL, Quigley HA, Dunkelberger G, Hohman RM, Addicks EM. Cell proliferation after laser photocoagulation in primate retina. an autoradiographic study. Arch Ophthalmol. 1986;104:1065–1069.

    CAS  PubMed  Google Scholar 

  250. Larsen ML, Moeller F, Sander B, Sjoelie AK. Subthreshold micropulse diode laser treatment in diabetic macular edema? Br J Ophthalmol. 2004;88:1173–1179.

    Article  Google Scholar 

  251. Luttrull JK, Musch DC, Mainster A. Subthreshold diode micropulse photocoagulation for the treatment of clinically significant diabetic macular oedema. Br J Ophthalmol. 2005;89:74–80.

    Article  CAS  PubMed  Google Scholar 

  252. Akduman L, Olk RJ. Subthreshold (invisible) modified grid diode laser photocoagulation in diffuse diabetic macular edema (DDME). Ophthalmic Surg Lasers Imaging. 1999;30:706–714.

    CAS  Google Scholar 

  253. Figueira J, Khan J, Nunes S, Sivaprasad S, Rosa A, Faria de Abreu J, et al. Prospective randomized controlled trial comparing subthreshold micropulse diode laser photocoagulation and conventional green laser for clinically significant diabetic macular oedema. Br J Ophthalmol. 2009;93:1341–1344.

    Google Scholar 

  254. Framme C, Schule G, Roider J, Birngruber R, Brinkmann R. Influence of pulse duration and pulse number in selective RPE laser treatment. Ophthalmic Surg Lasers Imaging. 2004;34:206–215.

    Google Scholar 

  255. Roider J, Hillenkamp F, Flotte T, Birngruber R. Microphotocoagulation: selective effects of repetitive short laser pulses. Proc Natl Acad Sci USA. 1993;90:8643–8647.

    Article  CAS  PubMed  Google Scholar 

  256. Friberg TR, Karatza EC. The treatment of macular disease using a micropulsed and continuous wave 810-nm diode laser. Ophthalmology. 1997;104:2030–2038.

    CAS  PubMed  Google Scholar 

  257. Roider J, Michaud NA, Flotte TJ, Birngruber R. Response of the retinal pigment epithelium to selective photocoagulation. Arch Ophthalmol. 1992;110:1786–1792.

    CAS  PubMed  Google Scholar 

  258. Framme C, Brinkmann R, Birngruber R, Roider J. Autofluorescence imaging after selective RPE laser treatment in macular diseases and clinical outcome: a pilot study. Br J Ophthalmol. 2002;86:1099–1106.

    Article  CAS  PubMed  Google Scholar 

  259. Roider J, Brinkmann R, Wirbelauer C, Laqua H, Birngruber R. Retinal sparing by selective retinal pigment epithelial photocoagulation. Arch Ophthalmol. 1999;117:1028–1034.

    CAS  PubMed  Google Scholar 

  260. Shima C, Ogata N, Minamoto K, Yoshikawa T, Matsuyama K, Matsumura M. Posterior sub-tenon injection of triamcinolone acetonide as pretreatment for focal laser photocoagulation in diabetic macular edema patients. Jpn J Ophthalmol. 2008;52:265–268.

    Article  CAS  PubMed  Google Scholar 

  261. Bonini-Filho MA, Jorge R, Barbosa JC, Calucci D, Cardillo JA, Costa RA. Intravitreal injection versus sub-tenon's infusion of triamcinolone acetonide for refractory diabetic macular edema: a randomized clinical trial. Invest Ophthalmol Vis Sci. 2005;46:3845–3849.

    Article  PubMed  Google Scholar 

  262. Cardillo JA, Melo LAS, Costa RA, Skaf M, Belfort R Jr, Souza-Filho AA, et al. Comparison of intravitreal versus posterior sub-tenon's capsule injection of triamcinolone acetonide for diffuse diabetic macular edema. Ophthalmology. 2005;112:1557–1563.

    Article  PubMed  Google Scholar 

  263. Jonas JB, Sofker A. Intraocular injection of crystalline cortisone as adjunctive treatment for diabetic macular edema. Am J Ophthalmol. 2001;132:425–426.

    Article  CAS  PubMed  Google Scholar 

  264. Gillies MC, Sutter FK, Simpson JM, Larsson J, Ali H, Zhu M. Intravitreal triamcinolone for refractory diabetic macular edema: two-year results of a double-masked, placebo-controlled, randomized clinical trial. Ophthalmology. 2006;113:1533–1538.

    Article  PubMed  Google Scholar 

  265. Audren F, Lecleire-Collet A, Erginay A, Haouchine B, Benosman R, Bergmann JF, et al. Intravitreal triamcinolone acetonide for diffuse diabetic macular edema: phase 2 trial comparing 4 mg vs. 2 mg. Am J Ophthalmol. 2006;142:794–799.

    Article  CAS  PubMed  Google Scholar 

  266. Avitabile T, Longo A, Reibaldi A. Intravitreal triamcinolone compared with macular laser grid photocoagulation for the treatment of cystoid macular edema. Am J Ophthalmol. 2005;140:695–702.

    CAS  PubMed  Google Scholar 

  267. DRCR Network. A Randomized Trial Comparing Intravitreal Triamcinolone Acetonide and Laser Photocoagulation for Diabetic Macular Edema. www.DRCR.net, 3-1. 2008.

  268. Jonas JB. Intravitreal triamcinolone acetonide for diabetic retinopathy. Dev Ophthalmol. 2007;39:96–100.

    Article  CAS  PubMed  Google Scholar 

  269. Audren F, Lecleire-collet A, Erginay A, Haouchine B, Benosman R, Bergmann JF, et al. Intravitreal triamcinolone acetonide for diffuse diabetic macular edema: phase 2 trial comparing 4 mg vs. 2 mg. Am J Ophthalmol. 2006;142:794–799.

    Article  CAS  PubMed  Google Scholar 

  270. LamD SC, Chan CKM, Mohamed S, Lai TYY, Li KKW, Li PSH, et al. A prospective randomised trial of different doses of intravitreal triamcinolone for diabetic macular edema. Br J Ophthalmol. 2007;91:199–203.

    Article  Google Scholar 

  271. Sivaprasad S, Ockrim Z, Massaoutis P, Ikeji F, Hykin PG, Gregor ZJ. Posterior hyaloid changes following intravitreal triamcinolone and macular laser for diffuse diabetic macular edema. Retina. 2008;28:1435–1442.

    Article  PubMed  Google Scholar 

  272. Kuppermann BD, Blumenkranz MS, Haller JA, Williams GA, Weinberg DV, Chou C, et al. Randomized controlled study of an intravitreous dexamethasone drug delivery system in patients with persistent macular edema. Arch Ophthalmol. 2007;125:309–317.

    Article  CAS  PubMed  Google Scholar 

  273. Haller JA, Dugel P, Weinberg DV, Chou C, Whitcup SM. Evaluation of the safety and performance of an applicator for a novel intravitreal dexamethasone drug delivery system for the treatment of macular edema. Retina. 2009;29:46–51.

    Article  PubMed  Google Scholar 

  274. Macugen Diabetic Retinopathy Study Group. A phase II randomized double-masked trial of pegaptanib, an anti-vascular endothelial growth factor aptamer, for diabetic macular edema. Ophthalmology. 2005;112:1747–1757.

    Article  Google Scholar 

  275. Shimura M, Nakazawa T, Shiono T, Iida T, Sakamoto T, Nishida K. Comparative therapy evaluation of intravitreal bevacizumab and triamcinolone acetonide on persistent diffuse diabetic macular edema. Am J Ophthalmol. 2008;145:854–861.

    Article  CAS  PubMed  Google Scholar 

  276. Roh MI, Byeon SH, Kwon OW. Repeated intravitreal injection of bevacizumab for clinically significant diabetic macular edema. Retina. 2008;28:1314–1318.

    Article  PubMed  Google Scholar 

  277. Do DV, Nguyen QD, Shah SM, Browning DJ, Haller JA, Chu K, et al. An exploratory study of the safety, tolerability and bioactivity of a single intravitreal injection of vascular endothelial growth factor (VEGF) trap-eye in patients with diabetic macular edema. Br J Ophthalmol. 2009;93:144–149.

    Article  CAS  PubMed  Google Scholar 

  278. Chun DW, Heier JS, Topping TM, Duker JS, Bankert JM. A pilot study of multiple intravitreal injections of ranibizumab in patients with center-involving clinically significant diabetic macular edema. Ophthalmology. 2006;113:1706–1712.

    Article  PubMed  Google Scholar 

  279. Ozkiris A. Intravitreal bevacizumab (Avastin) for primary treatment of diabetic macular edema. Eye. 2009;23:616–620.

    Article  CAS  PubMed  Google Scholar 

  280. Macugen Diabetic Retinopathy Study Group. Changes in retinal neovascularization after pegaptanib (Macugen) therapy in diabetic individuals. Ophthalmology. 2006;113:23–28.

    Article  Google Scholar 

  281. Lam DSC, Lai TYY, Lee VYW, Chan CKM, Liu DTL, Mohamed S, et al. Efficacy of 1.25 mg versus 2.5 mg intravitreal bevacizumab for diabetic macular edema. Six month results of a randomized controlled trial. Retina. 2009;29:292–299.

    Article  PubMed  Google Scholar 

  282. Ahmadieh H, Ramezani A, Shoeibi N, Bijanzadeh B, Tabatabaei A, Azarmina M, et al. Intravitreal bevacizumab with or without triamcinolone for refractory diabetic macular edema; a placebo-controlled, randomized trial. Graefe's Arch Clin Exp Ophthalmol. 2008;246:483–489.

    Article  CAS  Google Scholar 

  283. Soheilian M, Ramezani A, Bijanzadeh B, Yaseri M, Ahmadieh H, Dehghan MH, et al. Intravitreal bevacizumab (Avastin) injection alone or combined with triamcinolone versus macular photocoagulation as primary treatment of diabetic macular edema. Retina. 2007;27:1187–1195.

    Article  PubMed  Google Scholar 

  284. Iida T. Combined triamcinolone acetonide injection and grid laser photocoagulation: a promising treatment for diffuse diabetic macular edema. Br J Ophthalmol. 2007;91:407–408.

    Article  PubMed  Google Scholar 

  285. Kang SW, Sa HS, Cho HY, Kim JI. Macular grid photocoagulation after intravitreal triamcinolone acetonide for diffuse diabetic macular edema. Arch Ophthalmol. 2006;124:653–658.

    Article  CAS  PubMed  Google Scholar 

  286. Lam DSC, Chan CKM, Mohamed S, Lai TYY, Lee VYW, Liu DTL, et al. Intravitreal triamcinolone plus sequential grid laser versus triamcinolone or laser alone for treating diabetic macular edema. Six-month outcomes. Ophthalmology. 2007;114:2162–2167.

    Article  PubMed  Google Scholar 

  287. Hikichi T, Fujio N, Akiba J, Azuma Y, Takahashi M, Yoshida A. Association between the short-term natural history of diabetic macular edema and the vitreomacular relationship in type II diabetes mellitus. Ophthalmology. 1997;104:473–478.

    CAS  PubMed  Google Scholar 

  288. Yamaguchi Y, Otani T, Kishi S. Resolution of diabetic cystoid macular edema associated with spontaneous vitreofoveal separation. Am J Ophthalmol. 2003;135:116–118.

    Article  PubMed  Google Scholar 

  289. Lewis H, Abrams GW, Blumenkranz MS, Camp RV. Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction. Ophthalmology. 1992;99:753–759.

    CAS  PubMed  Google Scholar 

  290. Harbour JW, Smiddy WE, Flynn HW, Rubsamen PE. Vitrectomy for diabetic macular edema associated with a thickened and taut posterior hyaloid membrane. Am J Ophthalmol. 1996;121:405–413.

    CAS  PubMed  Google Scholar 

  291. Ikeda T, Sato K, Katano T, Hayashi Y. Improved visual acuity following pars plana vitrectomy for diabetic cystoid macular edema and detached posterior hyaloid. Retina. 2000;20:220–222.

    CAS  PubMed  Google Scholar 

  292. La Heij, Hendrikse F, Kessels AGH, Derhaag PJM. Vitrectomy results in diabetic macular oedema without evident vitreomacular traction. Graefe's Arch Clin Exp Ophthalmol. 2001;239:264–270.

    Article  Google Scholar 

  293. Tachi N, Ogino N. Vitrectomy for diffuse macular edema in cases of diabetic retinopathy. Am J Ophthalmol. 1996;122:258–260.

    CAS  PubMed  Google Scholar 

  294. Terasaki H, Kojima T, Niwa H, Piao CH, Ueno S, Kondo M, et al. Changes in focal macular electroretinograms and foveal thickness after vitrectomy for diabetic macular edema? Invest Ophthalmol Vis Sci. 2003;44:4465–5572.

    Article  PubMed  Google Scholar 

  295. Yamamoto T, Akabane N, Takeuchi S. Vitrectomy for diabetic macular edema: the role of posterior vitreous detachment and epimacular membrane. Am J Ophthalmol. 2001;132:369–377.

    Article  CAS  PubMed  Google Scholar 

  296. Yanyali A, Nohutcu AF, Horozoglu F, Celik E. Modified grid laser photocoagulation versus pars plana vitrectomy with internal limiting membrane removal in diabetic macular edema. Am J Ophthalmol. 2005;139:795–801.

    Article  PubMed  Google Scholar 

  297. Patel JI, Hykin PG, Schadt M, Luong VY, Fitzke F, Gregor ZJ. Pars plana vitrectomy with and without peeling of the inner limiting membrane for diabetic macular edema. Retina. 2006;26:5–13.

    Article  PubMed  Google Scholar 

  298. Tamamoto T, Hitani K, Tsukahara I, Yamamoto S, Kawasaki R, Yamashita H, et al. Early postoperative retinal thickness changes and complications after vitrectomy for diabetic macular edema. Am J Ophthalmol. 2003;135:14–19.

    Article  Google Scholar 

  299. Asami T, Terasaki H, Kachi S, Nakamura M, Yamamura K, Nabeshima T, et al. Ultrastructure of internal limiting membrane removed during plasmin-assisted vitrectomy from eyes with diabetic macular edema. Ophthalmology. 2004;111:231–237.

    Article  PubMed  Google Scholar 

  300. Hartley KL, Smiddy WE, Flynn HW Jr, Murray TG. Pars plana vitrectomy with internal limiting membrane peeling for diabetic macular edema. Retina. 2008;28:410–419.

    Article  PubMed  Google Scholar 

  301. Kumagai K, Furukawa M, Ogino N, Larson E, Iwaki M, Tachi N. Long-term follow-up of vitrectomy for diffuse nontractional diabetic macular edema. Retina. 2009;29:464–472.

    Article  PubMed  Google Scholar 

  302. Gandorfer A, Messmer EM, Ulbig MW, Kampik A. Resolution of diabetic macular edema after surgical removal of the posterior hyaloid and the inner limiting membrane. Retina. 2000;20:126–133.

    Article  CAS  PubMed  Google Scholar 

  303. Higuchi A, Ogata N, Jo N, Wada M, Matsumura M. Pars plana vitrectomy with removal of posterior hyaloid face in treatment of refractory diabetic macular edema resistant to triamcinolone acetonide. Jpn J Ophthalmol. 2006;50:529–531.

    Article  PubMed  Google Scholar 

  304. Thomas D, Bunce C, Moorman C, Laidlaw AH. Frequency and associations of a taut thickened posterior hyaloid, partial vitreomacular separation, and subretinal fluid in patients with diabetic macular edema. Retina. 2005;25:883–888.

    Article  PubMed  Google Scholar 

  305. Shah SP, Laidlaw DA. Vitrectomy for diabetic macular edema. Am J Ophthalmol. 2006;141:225.

    Article  PubMed  Google Scholar 

  306. Shah SP, Patel M, Thomas D, Aldington S, Laidlaw DAH. Factors predicting outcome of vitrectomy for diabetic macular edema: results of a prospective study. Br J Ophthalmol. 2006;90:33–36.

    Article  CAS  PubMed  Google Scholar 

  307. Massin P, Haouchine B, Gaudric A. Macular traction detachment and diabetic edema associated with posterior hyaloidal traction? Am J Ophthalmol. 2001;132:599.

    Article  CAS  PubMed  Google Scholar 

  308. Johnson MW. Tractional cystoid macular edema: a subtle variant of the vitreomacular traction syndrome? Am J Ophthalmol. 2005;140:184–192.

    PubMed  Google Scholar 

  309. Gaudric A. Macular cysts, holes, and cavitations. Graefe's Arch Clin Exp Ophthalmol. 2008;246: 1071–1079.

    Article  CAS  Google Scholar 

  310. Figueroa MS, Contreras I, Noval S. Surgical and anatomical outcomes of pars plana vitrectomy for diffuse nontractional diabetic macular edema. Retina. 2008;28:420–426.

    Article  PubMed  Google Scholar 

  311. Mochizuki Y, Hata Y, Enaida H, Yoshiyama K, Mitazaki M, Ueno A, et al. Evaluating adjunctive surgical procedures during vitrectomy for diabetic macular edema. Retina. 2006;26:143–148.

    Article  PubMed  Google Scholar 

  312. Heij ECL, Hendrikse F, Kessels AGH, Derhaag PJFM. Vitrectomy results in diabetic macular oedema without evident vitreomacular traction. Graefe's Arch Clin Exp Ophthalmol. 2001;239:264–270.

    Article  Google Scholar 

  313. Ando F, Yasui O, Hirose H, Ohba N. Optic nerve atrophy after vitrectomy with indocyanine green-assisted internal limiting membrane peeling in diffuse diabetic macular edema. Graefe's Arch Clin Exp Ophthalmol. 2004;242:995–999.

    Article  Google Scholar 

  314. Takaya K, Suzuki Y, Mizutani H, Sakuraba T, Nakazawa M. Long-term results of vitrectomy for removal of submacular hard exudates in patients with diabetic maculopathy. Retina. 2004;24:23–29.

    Article  PubMed  Google Scholar 

  315. Chang YH, Chen PL, Tai MC, Chen CH, Lu DW, Chen JT. Hyperbaric oxygen therapy ameliorates the blood-retinal barrier breakdown in diabetic retinopathy. Clin Exp Ophthalmol. 2006;34:584–589.

    Article  Google Scholar 

  316. Krott R, Heller R, Aisenbrey S, Bart-Schmidt KU. Adjunctive hyperbaric oxygenation in macular edema of vascular origin. Undersea Hyperb Med. 2000;27:195–204.

    CAS  PubMed  Google Scholar 

  317. Nguyen QD, Shah SM, Anden EV, Sung JU, Vitale S, Campochiaro PA. Supplemental oxygen improves diabetic macular edema: a pilot study. Invest Ophthalmol Vis Sci. 2004;45:617–624.

    Article  PubMed  Google Scholar 

  318. Sigurdsson R, Begg I. Organised macular plaques in exudative diabetic maculopathy. Br J Ophthalmol. 1980;64:392–397.

    Article  CAS  PubMed  Google Scholar 

  319. Avci R, Inan UU, Kaderli B. Long-term results of excision of plaque-like foveal hard exudates in patients with chronic diabetic macular edema. Eye. 2008;22:1099–1104.

    Article  CAS  PubMed  Google Scholar 

  320. Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy-ETDRS report number 9. Ophthalmology. 1991;98:766–785.

    Google Scholar 

  321. Maia OO Jr, Takahashi BS, Costa RA, Scott IU, Takahashi WY. Combined laser and intravitreal triamcinolone for proliferative diabetic retinopathy and macular edema: one-year results of a randomized clinical trial. Am J Ophthalmol. 2009;147:291–297.

    Article  CAS  Google Scholar 

  322. Mason JO III, Nixon PA, White MF. Intravitreal injection of bevacizumab (Avastin) as adjunctive treatment of proliferative diabetic retinopathy. Am J Ophthalmol. 2006;142:685–688.

    Article  PubMed  CAS  Google Scholar 

  323. McDonald HR, Schatz H. Macular edema following panretinal photocoagulation. Retina. 1985;5:5–10.

    Article  CAS  PubMed  Google Scholar 

  324. McDonald H, Schatz H. Visual loss following panretinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology. 1985;92:388–393.

    CAS  PubMed  Google Scholar 

  325. Nonaka A, Kiryu J, Tsujikawa A, Yamashiro K, Nishijima K, Kamizuru H, et al. Inflammatory response after scatter laser photocoagulation in nonphotocoagulated retina. Invest Ophthalmol Vis Sci. 2002;43(4):1204–1209.

    PubMed  Google Scholar 

  326. Er H, Doganay S, Turkoz Y, Cekmen M, Daglioglu MC, Gunduz A, et al. The levels of cytokines and nitric oxide in rabbit vitreous humor after retinal laser photocoagulation. Ophthalmic Surg Lasers. 2000;31(6):479–483.

    CAS  PubMed  Google Scholar 

  327. Shimura M, Yasuda K, Nakazawa T, Kano T, Ohta S, Tamai M. Quantifying alterations of macular thickness before and after panretinal photocoagulation in patients with severe diabetic retinopathy and good vision. Ophthalmology. 2003;110:2386–2394.

    Article  PubMed  Google Scholar 

  328. Shimura M, Yasuda K, Nakazawa T, Tamai M. Visual dysfunction after panretinal photocoagulation in patients with severe diabetic retinopathy and good vision. Am J Ophthalmol. 2005;140:8–15.

    PubMed  Google Scholar 

  329. Browning DJ. Visual dysfunction after panretinal photocoagulation in patients with severe diabetic retinopathy and good vision. Am J Ophthalmol. 2005;140:127–128.

    Article  PubMed  Google Scholar 

  330. Shimura M, Yasuda K, Shiono T. Posterior sub-tenon's capsule injection of triamcinolone acetonide prevents panretinal photocoagulation-induced visual dysfunction in patients with severe diabetic retinopathy and good vision. Ophthalmology. 2006;113:381–387.

    Article  PubMed  Google Scholar 

  331. Mason JO III, Yunker JJ, Vail R, McGwin G Jr. Intravitreal bevacizumab (Avastin) prevention of panretinal photocoagulation-induced complications in patients with severe proliferative diabetic retinopathy. Retina. 2008;28:1319–1324.

    Article  PubMed  Google Scholar 

  332. Blankenship G. A clinical comparison of central and peripheral argon laser panretinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology. 1988;95:170–177.

    CAS  PubMed  Google Scholar 

  333. Diabetic Retinopathy Clinical Research Network. Observational study of the development of diabetic macular edema following panretinal (scatter) photocoagulation given in 1 or 4 sittings. Arch Ophthalmol. 2009;127:132–140.

    Article  Google Scholar 

  334. Chung EJ, Roh MI, Kwon OW, Koh HJ. Effects of macular ischemia on the outcome of intravitreal bevacizumab therapy for diabetic macular edema. Retina. 2008;28:957–963.

    Article  PubMed  Google Scholar 

  335. Yang CM. Surgical treatment for severe diabetic macular edema with massive hard exudates? Retina. 2000;20:121–125.

    Article  CAS  PubMed  Google Scholar 

  336. Kang SW, Park SC, Cho HY, Kang JH. Triple therapy of vitrectomy, intravitreal triamcinolone, and macular laser photocoagulation for intractable diabetic macular edema. Am J Ophthalmol. 2007;144:878–885.

    Article  CAS  PubMed  Google Scholar 

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Browning, D.J. (2010). Diabetic Macular Edema. In: Browning, D. (eds) Diabetic Retinopathy. Springer, New York, NY. https://doi.org/10.1007/978-0-387-85900-2_7

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