Abstract

DO.13.05

Diabetic macular edema secondary to peripheral nonperfusion: A new etiology visualized by ultra-widefield fluorescein angiography and a novel treatment strategy

Suñer I. J. 
Duke University Medical School, Durham, USA

Objective: Diabetic macular edema (DME) is a leading cause of irreversible vision loss and legal blindness. A new etiology of diabetic macular edema secondary to peripheral nonperfusion and ischemia is described by a novel, ultra-widefield fluorescein angiography (UWFA) imaging procedure. This category of DME is likely results in production of vascular endothelial growth factor (VEGF) and resultant vascular permeability in the macula.
Methods: Clinically-significant diabetic macular edema was diagnosed by clinical examination by a retina expert. Patients were classified into this subgroup of DME secondary to peripheral nonperfusion/ischemia by ultra-widefield fluorescein angiography (UWFA) and optical coherence tomography (OCT). These patients underwent treatment by a combination of peripheral scatter laser photocoagulation (PRP) to the areas of nonperfusion and the perfusion-nonperfusion border and a single injection of a VEGF-inhibitor (Lucentis/ranibizumab or Avastin/bevacizumab). Success was measured by improvement in visual acuity and improvement/resolution of DME by clinical exam, UWFA, and OCT.
Results: The current strategy identifies a specific category of DME patients and represents successful treatment with a novel treatment strategy.
Conclusions: UWFA and OCT allows identification of a new category of DME secondary to peripheral ischemia/nonperfusion. A novel treatment strategy different than conventional macular laser or steroid therapy is described. This strategy is more successful than conventional approaches in this subcategory of patients as it addresses the underlying pathophysiology of this form of DME.

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