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Episode:

Strategies in Diabetes GETOCT 4
Category: Health
Duration: 00:00:00
Publish Date: 2012-07-01 10:45:59
Description:

Diabetes damages the blood vessels and if untreated, can lead to blindness. The newest discoveries with anti-VEGF therapy in diabetes have their own requirements. One question is when should a macular edema be treated and when not?
So far, a clinically significant macular edema was the main criterion for therapy. There has been a shift from clinically significant macular edema towards the concept of  “center involving or central subfiled thickening”.  With OCT, the course over time can now be controlled much more accurately.

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The question is, which concept is better: “clinically significant macular edema”  versus  “center involving”. In the label (package leaflet) of Lucentis is nothing written about retinal thickness. The single most important criterion is the visual acuity loss due to macular edema in diabetes. Monthly injections of Lucentis for three consecutive months until visual acuity is stable. Re-treatment, if the visual acuity is worse again. It is to discuss whether the visual acuity alone is a good parameter for treatment.
What is a “clinically significant macular edema”?
A GETOCT memory aid: important are two circles and a line (cross section papilla):
1. First inner circle with 500 microns around foveola
2. Second circle with one disc diameter around the the foveola
3. A line represents the disc diameter

The definition of clinically significant macular edema is important:
1.Retinal thickening within 500 microns of the center (foveola)
2.Hard exudates within 500 microns around the foveola with adjacent retinal thickening
3. Retinal thickening greater than one disc diameter in order to one disc area around foveola

The disadvantage of this arrangement is that the findings are not always clear.

Diabetes is a vascular disease
Diabetes affects vessels. Therefore, the assessment of the ischemic component is very important. Diabetes on the retina leads to a thinning of the peri foveolar capillary network. The normal fovelar avascular zone (FAZ) increases in size. Almost always, the lesions are irreversible. The capillary network is so badly damaged that swelling can not longer be caused, no edema is visible in advanced cases. In an avascular retina, OCT of the foveola shows completely thinner layers. The normal fine retinal layers are destroyed, but a few crumbs are visible. In very far-advanced stage, anti-VEGF and laser have no great benefit anymore for the visual acuity. The goal of therapy in very advanced situations is no longer the visual acuity, but to prevent vascular proliferations, thus bleeding and a secondary glaucoma or even blindness.

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Strategies in Diabetes GETOCT 4
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