Zusammenfassung
Das diabetische Makulaödem (DMÖ) ist für den Großteil der Visusminderungen bei Diabetikern
verantwortlich. Eine Reduktion der Sehschärfe durch ein DMÖ kann schon im milden nicht-proliferativen
Stadium der diabetischen Retinopathien (DR) auftreten [1]. Der chronische Verlauf der diabetischen Makulopathie erfordert ein intensives klinisches
Monitoring über einen langen Zeitraum. Dieser Beitrag gibt einen Überblick über das
diagnostische und therapeutische Management beim Vorliegen eines DMÖ.
Abstract
Diabetic macular edema (DME) is a chronic retinal disease, which requires intensive
clinical monitoring. Within the last ten years the intravitreal anti-VEGF (vascular
endothelial growth factor) therapy has become the standard of care to improve and
stabilize vision in patients with centre involving DME. Long-acting intravitreal corticosteroids
can achieve similar visual results with fewer injection rates. Because of steroid-induced
side effects (progression of cataract, glaucoma) these drugs are regarded as second-line
medication. Since the introduction of anti-VEGF-medication the focal laser photocoagulation
is no longer considered as first-line therapy for DME. However, a focal laser treatment
can sometimes be a possible alternative in specific situations. In patients with proliferative
diabetic retinopathy and DME, the intravitreal anti-VEGF therapy is approved for both
conditions. In ischemic maculopathy the functional outcome is restricted. For the
indication
of anti-VEGF-treatment for DME with accompanying central ischemia not only visual
acuity and optical coherence tomography parameters should be considered, the amount
of ischemia seen on fluorescein angiography should also be taken into account. In
tractional macular edema due to epiretinal membranes and vitreomacular adhesions a
pars-plana vitrectomy with membrane peeling is indicated.
Schlüsselwörter
Diabetes - Makulaödem - Angiografie - Laserphotokoagulation - Intravitreale Injektion
Key words
diabetes - macular edema - angiography - laser photocoagulation - intravitreal injection
