As discussed in a previous newsletter, all clinically significant macular edema (CSME) is Diabetic Macular Edema (DME), but not all DME is CSME. Furthermore, CSME is commonly divided into center-involving clinically significant macular edema (ci-CSME) and non-center-involving CSME (nci-CSME). In general, nci-CSME is managed with laser and ci-CSME is managed with anti-VEGF injections. Certainly, some cases of CSME are borderline for laser versus injections and undoubtedly we could debate many scenarios. But two simple case examples seem like a good place to start.
nci-CSME: At onset, there was clinically visible retinal thickening that was at least 1 disc area in size and within 1 disc area of the center of the fovea. This met criteria for CSME and warranted treatment. In this patient, one session of focal laser was applied and the patient remained stable for many years.
ci-CSME: At onset, there was clinically visible retinal thickening (shown via OCT, as you cannot see three dimensions on your computer screen!) involving the foveal center. This met criteria for CSME and warranted treatment. This patient was treated with four monthly injections of an anti-VEGF agent and had an excellent outcome.
Of course there are many nuances to treatment. The point is not to simplify everything into a sound bite. But you need to understand the basics in order to learn the complex.
The EyeCarePD Team