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Diabetic Retinopathy
Macular Edema in a Diabetic Patient
Diabetic Retinopathy Diabetic retinopathy is the leading cause of blindess in working age adults in the United States.
Diabetes affects several major systems in the body. It can cause kidney failure, nerve damage, and vascular damage. It increases
the risk of heart disease and stroke.
The effect of diabetes on the eye is generally classified as non-proliferative and proliferative retinopathy. Non-proliferative
diabetic retinopathy affects vision by causing swelling of the retina (macular edema). Macular edema disrupts the function of the
retina and leads to vision loss. Macular edema is treated by laser. Prior to the laser treatment a fluorescein angiogram is performed
to pinpoint the exact areas of leakage to be treated. This laser treatment may need to be repeated at a later point. At times when
the swelling does not resolve with laser treatment the retina specialist may consider placement of a steroid inside the eye
(Intravitreal Kenalog). This is a newer treatment supported by small case series. Intravitreal Kenalog is performed in the office
with topical anesthesia.
Macular Edema in a Diabetic Patient
Proliferative diabetic retinopathy affects vision by causing bleeding inside the eye (vitreous hemorrhage) or retinal detachment.
Abnormal blood vessels grow out of the retina and may break and bleed. This blood in the vitreous can cause sudden severe loss of
vision. These abnormal blood vessels may also contract and pull on the retina and cause a tractional retinal detachment. Retinal
detachment may also cause devastating loss of vision. The best time to treat Proliferative Diabetic Retinopathy (PDR) is at the
early stage when abnormal vessels just start to grow. Treatment is performed with laser in the office. If bleeding or retinal
detachment is encountered a vitrectomy may be needed.
Vitrectomy is a procedure performed in the operating room where specialized equipment is used to remove the blood from the eye and
remove the membranes that have pulled and detached the retina.
The importance of regular dilated eye examinations for people with diabetes can not be stressed enough. It is best to catch the
disease at an early stage and slow any progression than try to fix the damages after the fact. Controlling ones blood sugar and
blood pressure is also very important in slowing down the progression of any retinopathy.
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