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Macular Edema: Pathogenesis, Diagnosis, and Treatment

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (10 October 2023) | Viewed by 6925

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Prof. Dr. Simone Donati

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Guest Editor

Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
Interests: retinal diseases; macular edema; age-related macular degeneration; vitreoretinal surgery

Prof. Dr. Daniele Veritti

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Guest Editor

Department of Medicine – Ophthalmology, University of Udine, 33100 Udine, Italy
Interests: vitreo-retinal diseases; macular edema; age-related macular degeneration; artificial intelligence

Special Issue Information

Dear Colleagues,

Macular edema causes visual impairment in various retinal pathologies. Inflammatory, vascular and degenerative factors influence its pathogenesis, persistence and recurrence. Vitreoretinal interaction and choroidal modifications influence its characteristics.

The advent of non-invasive high-resolution imaging techniques, especially optical coherence tomography, has made it possible to study in detail a broad spectrum of related retinal diseases, including age-related macular degeneration, diabetic retinopathy, retinal vein occlusions, vitreomacular interface disorders (i.e., macular holes, epiretinal membranes, etc.), retinal detachment, posterior uveitis and inherited retinal dystrophies. New diagnostic instruments can identify biomarkers and clinical signs which are predictive for loss of visual acuity and disease activity.

New intravitreal drugs and delivery systems are being applied or studied to treat macular edema, with the aim to reduce recurrences and to control retinal damage.

The aim of this review is to focalize and underline clinical and experiemental research and literature metanalyses related to diagnosis and therapy of macular edema, based on new drugs and imaging techniques.

Prof. Dr. Simone Donati
Prof. Dr. Daniele Veritti
Guest Editors

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Keywords

vitreoretinal interface
retinal vascular diseases
posterior uveitis
cystoid macular edema
OCT
OCT-angiography

Published Papers (4 papers)

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Research

8 pages, 3129 KiB

Open AccessArticle

Comparison of the Effectiveness of Intravitreal Bevacizumab Injections with and without Simultaneous Cataract Surgery in Diabetic Patients with Macular Edema

by Jeeyoung Kwak, You Hyun Lee, Kyung Tae Kang and Yu Cheol Kim

J. Clin. Med. 2023, 12(12), 4060; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12124060 - 15 Jun 2023

Viewed by 1061

Abstract

Intravitreal bevacizumab (IVB), often injected during cataract surgery, is currently the main treatment for diabetic macular edema. This retrospective study aimed to compare the effectiveness of IVB injections alone and during cataract surgery in patients with diabetic macular edema. We examined 43 eyes in 40 patients who underwent cataract surgery with simultaneous IVB injections 3–12 months after IVB injections alone. Best-corrected visual acuity and central subfield macular thickness (CMT) were measured 1-month post-injection. The CMTs of the same eyes with IVB-only first and combined-treatment procedures later were 384 ± 149 vs. 315 ± 109 μm pretreatment (p = 0.0002), and after 1 month, they were 319 ± 102 vs. 419 ± 183 μm (p < 0.0001). In the IVB-only procedure, 56.1% of eyes had CMT < 300 μm 1 month after the injection compared to 32.5% after the combined treatment. Therefore, on average, when IVB was administered during cataract surgery, CMT increased, whereas after IVB injection alone, it effectively decreased. More prospective trials with large sample sizes are needed to evaluate the effectiveness of IVB injection performed simultaneously with cataract surgery. Full article

(This article belongs to the Special Issue Macular Edema: Pathogenesis, Diagnosis, and Treatment)

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11 pages, 33606 KiB

Open AccessArticle

Choroidal Thickness in Different Patterns of Diabetic Macular Edema

by Rida Amjad, Cheong-Ah Lee, Hafiz Muhammad Umer Farooqi, Hina Khan and Dong-Guk Paeng

J. Clin. Med. 2022, 11(20), 6169; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11206169 - 19 Oct 2022

Cited by 11 | Viewed by 2872

Abstract

This observational study investigated the changes in choroidal thickness (ChT) in different patterns of diabetic macular edema (DME) based on image processing using enhanced-depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT). Participants with ocular conditions affecting the fundus view, including retinal diseases, were excluded. After observing the patient’s medical record, multicolor fundus photos, thickness maps, and subtypes of DME were diagnosed according to the criteria reported by the Early Treatment Diabetic Retinopathy Study (ETDRS). Edema was classified as focal or diffuse and was subdivided into cystic macular edema (CME), CME with subretinal fluid (CME+), and spongy macular edema (SME). Image processing was performed on the B-scan images from SD-OCT to segment the choroid layer and obtain the choroid thickness. A total of 159 eyes of 81 patients (46 males and 35 females; 57.53 ± 9.78 years of age), and 57 eyes of 30 healthy individuals (age 57.34 ± 8.76 years) were enrolled in this study. Out of 159 eyes, 76 had focal macular edema (FME), 13 exhibited SME, and 51 presented CME. Among those with cystic macular edema, 19 eyes showed subretinal fluid (CME+). The average choroidal thickness in FME, diffuse SME, CME, and CME+ was 216.95 ± 52.94 µm, 243.00 ± 46.34 µm, 221.38 ± 60.78 µm, and 249.63 ± 53.90 µm, respectively. The average choroidal thickness in age-matched controls was 213.88 ± 45.60 µm. Choroidal thickness increases with the severity of edema; choroidal thickness was higher in diffuse macular edema than in FME. However, choroidal thickness increased in cystic macular edema with subretinal fluid (CME+). Full article

(This article belongs to the Special Issue Macular Edema: Pathogenesis, Diagnosis, and Treatment)

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10 pages, 967 KiB

Open AccessArticle

Topical NSAIDs and Oral Acetazolamide for Macular Edema after Uncomplicated Phacoemulsification: Outcome and Predictors of Non-Response

by Wissam Aljundi, Loay Daas, Yaser Abu Dail, Barbara Käsmann-Kellner, Berthold Seitz and Alaa Din Abdin

J. Clin. Med. 2022, 11(19), 5537; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11195537 - 21 Sep 2022

Cited by 2 | Viewed by 1326

Abstract

Purpose: To investigate the effectiveness of nonsteroidal anti-inflammatory eye drops (NSAIDs) combined with oral acetazolamide for postoperative macular edema (PME) after uncomplicated phacoemulsification (PE) and identify predictors of non-response. Methods: We analyzed data of uncomplicated PE and identified eyes with PME. First-line therapy included topical NSAIDs combined with oral acetazolamide. In the case of non-response, triamcinolone was administered subtenonally. Outcome measures included best-corrected visual acuity (BCVA) and central macular thickness (CMT). Results: 94 eyes out of 9750 uncomplicated PE developed PME, of which 60 eyes were included. Follow-ups occurred 6.4 ± 1.8, 12.5 ± 3.7 and 18.6 ± 6.0 weeks after diagnosis. BCVA and CMT improved significantly in all follow-ups. In total, 40 eyes showed a response to first-line therapy at the first follow-up (G1). The remaining 20 eyes showed no response and required subtenon triamcinolone (G2), of which 11 eyes showed complete regression at the second follow-up and 4 eyes at third follow-up. A further 5 eyes showed no response and required intravitreal injection. Multivariate linear regression model showed that Diabetes mellitus (DM) and increased cumulative dissipated energy (CDE) are predictors of non-response. Conclusion: Topical NSAIDs with acetazolamide resulted in complete regression of PME in 67% of all cases. DM and increased CDE might be considered as predictors of non-response to this treatment. Full article

(This article belongs to the Special Issue Macular Edema: Pathogenesis, Diagnosis, and Treatment)

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7 pages, 1607 KiB

Open AccessCommunication

Hydrodynamic Analysis of the Clinical Findings in Pachychoroid-Spectrum Diseases

by Okihiro Nishi and Tsutomu Yasukawa

J. Clin. Med. 2022, 11(17), 5247; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11175247 - 5 Sep 2022

Viewed by 1182

Abstract

We wish to demonstrate that theorems of fluid dynamics may be employed to hydrodynamically analyze the clinical presentations seen within the pachychoroid-spectrum diseases (PSD). Methods: We employed both the Equation of Continuity Q = A · V in which Q represents blood flow volume, A the sectional area of a vessel, and V blood flow velocity as well as Bernoulli’s Principle 1/2 V² + P/ρ = constant where V represents blood flow velocity, P static blood pressure and ρ blood density. The Equation of Continuity states that a decrease in flow volume occurs simultaneously with a decrease in the flow velocity and/or sectional area, and vice versa. Bernoulli’s Principle states that a decrease in the velocity of a fluid occurs simultaneously with an increase in static pressure, and vice versa. Results: Hyperpermeability of the choriocapillaris, as visualized on fluorescein angiography and indocyanine green angiography (ICGA), causes a fluid exudation and, therefore, a decrease in the blood flow volume Q which elicits a simultaneous decrease in the blood flow velocity V clinically observable in filling delay into the choriocapillaris on ICGA. An increase in the static blood pressure P will simultaneously occur in venules in accord with Bernoulli’s Principle. Conclusions: A decrease in the blood flow velocity in the choriocapillaris due to its hyperpermeability will hydrodynamically elicit an increase in the blood pressure in venules. This blood pressure rise may expand Sattler and Haller veins, forming pachyveins. The primary lesion of PSD can be in pigment epithelium and choriocapillaris. Full article

(This article belongs to the Special Issue Macular Edema: Pathogenesis, Diagnosis, and Treatment)

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