Macular edema may be intracellular or extracellular. Intracellular accumulation of fluid (cytotoxic edema) is an alteration of the cellular ionic distribution. Extracellular accumulation of fluid is more frequent and clinically more relevant, and is directly associated with an alteration of the blood-retinal barrier. Fluorescein angiography has been critical for detecting macular edema and currently remains the ‘gold standard’ for its diagnosis by identifying the characteristic stellar pattern of cystoid macular edema, also providing a qualitative assessment of vascular leakage essential for identifying treatable lesions. The clinical diagnosis of macular edema, recognition of its main etiologies and its treatment have greatly improved due to multiple and remarkable advances in modern imaging technologies. By correlating results from fluorescein angiography and optical coherence tomography (OCT), fluid accumulation within and under the sensory retina can be confirmed and located. We are now able to measure changes in retinal thickness and use noninvasive instrumentation in a clinical setting to identify macular edema. Moreover, spectral-domain OCT can characterize the presence and integrity of the external limiting membrane and the photoreceptor inner and outer segments, which is useful information for prognosis as well as a guide for treatment. The diagnosis of macular edema and its clinical forms is now based primarily on the correlation of these imaging techniques.

Keywords:
Macular edema, Diagnosis
1.
Gass JD: Stereoscopic Atlas of Macular Diseases. Diagnosis and Treatment, ed 4. St. Louis, Mosby, 1997, p 1061.
2.
Kohner EM, Henkind P: Correlation of fluorescein angiogram and retinal digest in diabetic retinopathy. Am J Ophthalmol 1970;69:403–414.
3.
Coscas G, Dhermy P: Occlusions veineuses rétiniennes. Rapport Société Française d’Ophtalmologie. Nancy, Masson, 1978, p 484.
4.
Richard G, Soubrane G, Yannuzzi LA: Fluorescein and ICG Angiography, ed 2. Stuttgart, Thieme, 1998, chapt 2, pp 15–16.
5.
Coscas G: Atlas of Indocyanine Green Angiography. Paris, Elsevier, 2005.
6.
Bernardes R, Lobo C, Cunha-Vaz JG: Multimodal macula mapping: a new approach to study diseases of the macula. Surv Ophthalmol 2002;47:580–589.
7.
Coscas G: Optical Coherence Tomography in Age-Related Macular Degeneration. OCT in AMD. Heidelberg, Springer, 2009.
8.
Margolis R, Kaiser PK: Diagnostic modalities in diabetic retinopathy; in Duh E (ed): Diabetic Retinopathy. Totowa, Humana, 2008, pp 109–133.
9.
Hee MR, Puliafito CA, Duker JS, et al: Topography of diabetic macular edema with optical coherence tomography. Ophthalmology 1998;105:360–370.
10.
Otani T, Kishi S, Maruyama Y: Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol 1999;127:688–693.
11.
Alkuraya H, Kangave D, Abu El-Asrar AM: The correlation between optical coherence tomography features and severity of retinopathy, macular thickness and visual acuity in diabetic macular edema. Int Ophthalmol 2005;26:93–99.
12.
Brown JC, Solomon SD, Bressler SB, Schachat AP, DiBernardo C, Bressler NM: Detection of diabetic foveal edema: contact lens biomicroscopy compared with optical coherence tomography. Arch Ophthalmol 2004;122:330–335.
© 2010 S. Karger AG, Basel
2010
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