What is diabetic maculopathy

Diabetic maculopathy is characterized by the presence of microaneurysms, flame-like haemorrhages, cotton-wool like or even hard exudates

Diabetic Maculopathy Pictures
Figure 13.1. Photograph of the retina of the patient showing multiple exudates, micro-haemorrhages and micro-aneurysms on the macula area, as well as scars from previous Laser photocoagulation.

and oedema, at a distance of one disk diameter (1500 mm) from the centre of the macula (Figure 13.1). The possibility of macular damage is higher as the disease progresses and proportional to the stage severity (2-3 percent in background DR and 20-71 percent in proliferative DR). Depending on the lesions present and the mechanism of their production, the following types of diabetic maculopathy exist:

• Focal or exudative maculopathy: this is characterized by focal dye leakage during fluorescein angiography and by hard exudates circularly arranged.

• Diffuse or oedematous maculopathy: there is dilatation of the retinal capillaries and arterioles, with diffuse leakage of fluid. The increased vascular permeability and impaired function of the pigmented epithelium pump are implicated in the causation of these lesions. The absence of hard exudates and the presence of cystic retinal lesions in the area of the macula, when fluid accumulation increases a lot, are characteristic of this type of diabetic maculopathy as well.

• Ischaemic maculopathy: this is characterized by an intense aberration of the perimacular net architecture (extensive degradation - expansion).

Ophthalmoscopic features of ischaemia are the presence of muddy oedema, multiple cotton-wool like exudates and white obstructed arterioles. Prognosis is poor - no response to laser treatment - and there is significant reduction in visual acuity.

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