What Is the Treatment for Macular Edema?

Macular edema refers to the inflammatory reaction of the macular region of the fundus retina most sensitive to light, the infiltration of fluid, the formation of edema, and severe vision loss. It is a central retinal vein occlusion, diabetic retinopathy, and an important cause of vision loss. One. Macular edema should generally be treated for primary disease, and anti-inflammatory treatment should be given for inflammation caused by the eye.

Basic Information

English name

macular edema

Visiting department

Ophthalmology

Common locations

Macula

Common causes

Macular area caused by inflammatory reaction and fluid infiltration

Causes of macular edema and common diseases

1. Surgical complications: They can occur after almost all internal eye surgery, including laser photocoagulation and condensation surgery. The peak incidence of cataract surgery is about 6-10 weeks after surgery.

2. Diabetic retinopathy.

3. Central retinal vein occlusion and branch retinal vein occlusion.

4. Uveitis, especially intermediate uveitis.

5. Retinitis pigmentosa.

6. Use local eye drops: such as epinephrine, dipifurin, etc., especially for patients after cataract surgery. Macular cystoid edema is often reversible after discontinuation.

7. Retinal vasculitis: such as retinal venous inflammation (Eales disease), Behcet disease, sarcoidosis, necrotizing vasculitis, multiple sclerosis, cytomegalovirus retinitis.

8. Retinal telangiectasia: such as outer exudative retinopathy (Coats disease).

9. Age-related macular degeneration (ARMD): There is usually a chronic choroidal neovascular membrane (CNVM).

10. Others: intraocular tumors, hypertension, connective tissue disease, autosomal hereditary CMR, etc.

11. Pseudomacular cystoid edema: No leakage of FFA. Such as nicotinic maculopathy (when relatively high doses of niacin are used to treat high cholesterol), sexually linked hereditary retinal schizophrenia, Goldmann-Favre disease, and anterior retinal membrane formation.

Differential diagnosis of macular edema

Central serous choroidal retinopathy

It is more common in young men and women. There is serous discoid retinal detachment and / or serous retinal pigment epithelium (RPE) detachment in the macula, which is self-limiting and has a tendency to relapse. Serous RPE detachment; fluorescence contrast of macular cystoid edema is the accumulation of petal-shaped fluorescent dye in the macula.

Intraocular tumor

Whether benign or malignant masses, especially choroidal hemangiomas, are often accompanied by superficial retinal detachment of the macular region and / or macular cystoid edema, detailed examination of the fundus with binocular indirect ophthalmoscope can avoid misdiagnosis and treatment errors.

3. Central retinal artery occlusion

This is an emergency case with a complaint of sudden vision loss. There is a cherry red spot on the fundus of the eye. The posterior pole retina has a milky swelling. This is the swelling of the cells and intracellular fluid. , Arterial non-filling or delayed filling or prolonged circulation time, etc., fluorescence contrast and CME have completely different characteristics, the two are easy to distinguish.

Macular edema examination

Medical history

Whether you have a recent history of internal eye surgery, diabetes, previous family history of uveitis or eye infections, night blindness or eye disease, and whether there is a history of useful medicines, including topical use of epinephrine, dipifolin, and other drugs.

2. Eye examination

Includes an assessment of the surrounding fundus (requires compression of the sclera to examine the periphery). It is best to use a slit lamp in combination with a three-sided mirror, a front mirror or a 60 / 90D lens for macular examination.

3. Fundus fluorescein angiography

Capillary vessels around the fovea often show fluorescence leakage in early stages, and macular fluorescence staining in late stages, typically flower petals or spokes.

4. Retinal Optical Coherence Tomography

It is helpful to diagnose and judge the existence of lamellar and full-layer cracks.

5. Other inspections

If indicated, other diagnostic tests can be performed, such as rapid blood glucose tests, glucose tolerance tests, and ERG.

Macular edema treatment principles

The treatment of macular cystoid edema should generally treat the primary disease. Anti-inflammatory drugs such as retinal vasculitis and uveitis should be given for intraocular inflammation. Adrenal corticosteroids can be given.