diabetic maculopathy

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This condition is more common in older, non-insulin dependent diabetics, and is the most common cause of gradual loss of vision in a patient with non-proliferative diabetic retinopathy.

  • this involves
    • the breakdown of the blood–retinal barrier
    • leakage of plasma from small blood vessels in the macula
    • swelling of the central retina
    • formation of hard exudates
  • diabetic macular oedema
    • does not cause total blindness (1)
    • leads to severe loss of central vision (1)
    • most common presenting clinical symptom is blurred vision
    • (2)
      • other symptoms can include metamorphopsia (distortion of visual image), floaters, change in contrast sensitivity, photophobia (visual intolerance to light), changes in color vision, and scotomas (localized defects of visual field)
  • clinically significant macular oedema is
    • retinal thickening and/or
    • adjacent hard exudates that either involve the center of the macula

Four types of diabetic maculopathy are recognised:

  • cystoid:
    • characterised by microaneurysms and haemorrhages but relatively few, if any, hard exudates
    • the main feature is extensive macular oedema which if persistent, may lead to a lamellar hole at the fovea with permanent impairment of visual acuity
  • focal - a background diabetic retinopathy, associated with macular oedema and surrounding hard exudates
  • ischaemic - similar ophthalmic picture to cystoid and differentiated from it by fluorescein angiography
  • mixed - exudates, oedema and ischaemia


  1. Frank RN. Diabetic Retinopathy.N Engl J Med 2004;350:48.
  2. Rittiphairoj T, Mir TA, Li T, Virgili G. Intravitreal steroids for macular edema in diabetes. Cochrane Database of Systematic Reviews 2020, Issue 11. Art. No.: CD005656. DOI: 10.1002/14651858.CD005656.pub3.

Last edited 12/2020 and last reviewed 12/2020