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OCT, fluorescein angiography may differentiate subtypes of diabetic macular edema
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KOLOA, Hawaii — Different image patterns on optical coherence tomography and fluorescein angiography may signify distinct causes of diabetic macular edema, which may, in turn, be a tip-off to the most effective treatment plan.
 Scott W. Cousins |
"Is the biology different, and therefore the treatment different, between focal and diffuse leakage?" Scott W. Cousins, MD, asked attendees at Retina 2010.
A focal leakage pattern exemplified by speckled thickening on OCT and leakage on fluorescein angiography may typify a vasogenic mechanism, most likely due to leaking micro-aneurysms, Dr. Cousins said. These patients may respond best to laser therapy.
If OCT shows presence of cysts and fluorescein angiography the presence of significant leakage, an underlying toxic mechanism may be the ultimate cause of diabetic macular edema, suggesting that pharmacotherapy may be appropriate, Dr. Cousins said. In these cases, the diffuse leakage pattern may result from the inability of Müller cells to pump blood into the vasculature, leading to the swollen appearance recognized as a cyst.
In diffuse presentations, poor peripheral perfusion of the retina appears to suggest over-expression of VEGF and, thus, an indication for anti-VEGF therapy, whereas significant peripheral perfusion suggests an inflammatory etiology, which portends a better response to steroid therapy, Dr. Cousins said.
Hawaiian Eye and Retina 2011 will be held January 16-21, 2011 at the Hyatt Regency Maui Resort & Spa in Ka'anapali, Maui. Learn more at OSNHawaiianEye.com.