Causes Symptoms Diagnosis Treatment Our capabilities Price for treatment
Macular edema, is edema of the central area called the retina, which is called the macula. It is this area of an eye is responsible for the central vision.
Macular edema is not an independent disease, it is only a symptom that is observed in certain diseases of an eye: diabetic retinopathy, uveitis, retinal vein thrombosis. In addition, macular edema may occur due to trauma or after eye surgery.
Causes of occurance
Macular edema occurs as a consequence of accumulation of the fluid in the central area of the retina, thus significantly reducing the visual acuity. There are quite a lot of factors leading to this.
In 1953, macular edema was firstly described, which occurred after the cataract surgery. This postoperative complication is called Irving-Gass syndrome, named by the doctor, who had described it. The cause and pathogenesis of this syndrome remains controversial till this day. It is found that the kind of ophthalmic surgery is directly related to the frequency of macular edema occurrence. For example, the extracapsular cataract extraction may cause its appearance more often (about 6%) than intracapsular removal of the lens.
In diabetic retinopathy, retinal edema occurs, including the macula, which is associated with the violation of capillary permeability: the liquid is sweated through their defective vascular wall, accumulating in the retina.
Thrombosis of central retinal vein or its branches also increases the permeability of blood vessels, which contributes to the output fluid in perivascular space and thereby the retinal edema is formed.
In addition, macular edema may occur with the vitreoretinal traction, manifested by the formation of strands between the retina and the vitreous body. They are found in vascular and inflammatory diseases and injuries of the vision organ, causing the macula edema, and in the worst-case - and its rupture.
Symptoms of macular edema
• blurred central vision
• distorted image – the straight lines appear wavy, the pinkish hue appears
• a special sensitivity to the light
• the cyclical decline of the visual acuity, inherent in a certain time of the day (usually in the morning)
• changes in the refraction (0.25 diopters)
• Differences in color perception during the day (are rare).
It is worth noting that the long-existing macular edema may cause the irreversible phenomena in the structure of the retina that irreparably impairs the vision.
With diabetes, on the background of retinopathy focal and diffuse macular edema may occur. Macular edema is considered diffuse, when the area of the retinal thickening reaches to 2 or more diameters of the optic nerve, with the spreadness on the center of the macula, and focal - if it does not exceed 2 square diameter of the disc and the center of the macula does not capture. Mainly the long-term diffuse edema is often accompanied by a significant decrease of the visual acuity and leads to the degeneration of the retinal pigment epithelium, macular rupture, epiretinal membrane.
Diagnostics
To diagnose the ophthalmoscopy (fundus examination) is appointed, which can reveal a pronounced macular edema. In the case of unexpressed edema, it is quite difficult to find.
The initial stage of retinal edema in its central area can usually be suspected due to some tarnish edematous area. In addition, the bulging of the the macula area is a sign of edema, which is detected by the characteristic curve of the vessels, if the examination of the eye fundus is carried out with the slit lamp. Foveolar reflex disappears that points directly to the fact that there was a flattening of the fovea.
However, nowadays there are modern methods of examination, allowing to reveal even the smallest deviation in the morphology of the retina. These methods, for example, the optical coherence tomography refers (OCT). The data of the examination indicates the thickness of the retina in micrometers, its volume in the cubic millimeters and the structure of the retina and vitreoretinal ratio.
Another way to confirm macular edema is the fluorescent angiography of the retina, which is in a contrast examination of the retinal vessels. Edema is determined by the largest portion of contrast dispersion, which has no clear boundaries. Also, the fluorescent angiography of the retina makes it possible to determine the source of weating liquid.
Treatment
Macular edema is treated with the conservative, laser or surgical method. The tactic of patients’ observation is completely dependent on edema length of existence and its causes.
During the conservative treatment of macular edema anti-inflammatory drugs in drops, injections or tablets are used. The corticosteroids and nonsteroidal antiinflammatory drugs are assigned. The main advantage of the appointment of nonsteroidal antiinflammatory drugs (NSAIDs) is the lack of side effects that occur during treatment with corticosteroids, such as increased intraocular pressure, reduced local immunity and ulceration of deepithelialized corneal parts. To increase the effectiveness of cataract surgery, NSAIDs are used in the preoperative preparation. Instillation of NSAIDs are prescribed for a few days before the operation and then continue in the postoperative period, as a means of anti-inflammatory therapy. Their use is regarded as prevention of postoperative macular edema and its treatment of the subclinical forms.
Lack of effect of the application of conservative therapy necessitates the introduction of certain drugs into the vitreous, such as corticosteroids or long-acting drugs, specifically for intravitreal injection.
The presence in the vitreous of the distinct changes – traction or epiretinal membranes – is an indicator for the vitrectomy (removal of the vitreous).
The effective treatment of macular edema in diabetes is the retinal laser photocoagulation. Moreover, the early stage laser treatment is a crucial prerequisite. The effectiveness of laser photocoagulation is proved with the focal macular edema. However, according to many scientists, despite the treatment of diffuse edema laser projections of preservation of visual function are disappointing.
While macular edema the essence of laser coagulation of the retina is reduced to cauterization of defective vessels, because of the fragility the leakage of the fluid occurs. The center of the retina remains unaffected by the laser.
The benefits of treatment to the MEC
It is not superfluous to recall that the success of the treatment of macular edema depends on its early diagnosis and, therefore, there must be examination by the doctor. So be careful and pay attention to the most seemingly minor symptoms, especially if you have diabetes mellitus, the central retinal vein thrombosis, or had surgery on the eyeball in the recent past.
In case if you are facing a dilemma where to go for an eye care or about preventive eye examination, come to " Moscow Eye Clinic." Professionals, working with us, have extensive clinical experience of diagnosis and treatment of most known eye diseases. Vitreoretinal and Laser Surgeries of the Clinic are the best and the most popular in its sphere. At the clinic vitreoretinal surgery Ilyuhin Oleg works, who has more than 5000 complex surgeries on the posterior segment of an eye. Leonid Grigorievich Estrin works using laser treatments at MEC, the doctor of the highest category with the experience of over 30 years.
The first-class modern ophthalmologic equipment, including the most advanced surgical devices, as well as the newest lasers are collected in our center. For the patients’ convenience, we work seven days a week from 9 am till 9 pm, have their own hospitals.
Cost of treatment
The cost of treating macular edema at "MEC" is calculated individually and will depend on the amount of the therapeutic and diagnostic procedures. To clarify the value of a procedure, you may by calling 8 (800) 777-38 81 and (499) 322-36-36, or online using the appropriate form on the site you may also read the section "Prices".
