Ophthalmology

Statement of the problem: Intravitreal anti-VEGF medications and steroids, and often laser photocoagulation, are routinely used in the major studies for treating diabetic macular edema (DME), including focal type, diffuse (DDME), epiretinal membrane (ERM) -associated and even ischemic-related. However, lucentis treatment, for example, failed in more than 50% of eyes. On the other hand, there are DDME eyes that respond well to grid laser prior to administration of any medication. And, there are many so called "non-tractional" DDME eyes, with neither vitreofoveal traction nor ERM that respond well to pars plana vitrectomy (PPV) after repeat failures of the alternative treatments. If we had known the distinctiveness of these DDME eyes, we could probably treat them rightly by either Early PPV or grid laser, avoiding intravitreal medications.

Methodology: Using full-field 3D SD-OCT (Topcon-1000) that scans point by point continuously, rather than by separate lines, and thus provides 3D data and 360⁰ video clips; and following search at extramacular sites, I present our published pathogeneses of DDME.

Conclusions & significance: By using full-field 3D-OCT imaging, we present the pathogeneses of diffuse DME. A proper durable treatment would be aimed towards the pathogenesis: PPV or observation in tractional DDME and laser photocoagulation in non-tractional DME, both in focal and diffuse types. The outcome of the hundreds of DME treatment studies is now clearer.