Abstract
Background
To report the role of retinal hypoxia in development of diabetic macular edema and its management—a new concept.
Case report
A 24-year-old diabetic female was seen with bilateral visual blurring for 3 weeks, associated with marked diabetic macular edema, diabetic retinopathy, and non-arteritic anterior ischemic optic neuropathy (NA-AION) in both eyes. She was taking three blood pressure lowering drugs for diabetic neuropathy and nephropathy. Stopping two of those arterial hypotensive drugs, without any of the conventional treatments for diabetic macular edema, resulted in rapid improvement of visual acuity from counting fingers to 20/50 in the right eye, and from 20/80 to 20/25 in the left eye, and complete resolution of macular edema and improvement of retinopathy. Similarly, visual field defects in both eyes improved to almost normal.
Conclusions
The evidence from this diabetic patient suggests that hypoxia caused by fall in perfusion pressure in the retinal capillaries may be playing an important role in the development of diabetic macular edema in some, perhaps many, of these cases.
Similar content being viewed by others
References
Hayreh SS, Zahoruk RM (1981) Anterior ischemic optic neuropathy VI. In juvenile diabetics. Ophthalmologica 182:13–28
Hayreh SS (2002) Diabetic papillopathy and nonarteritic anterior ischemic optic neuropathy. Surv Ophthalmol 47:600–602
Hayreh SS, Zimmerman MB (2007) Optic disc edema in non-arteritic anterior ischemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol 245:1107–1121
Hayreh SS, Zimmerman MB (2007) Incipient non-arteritic anterior ischemic optic neuropathy. Ophthalmology 114:1763–1772
Hayreh SS, Joos KM, Podhajsky PA, Long CR (1994) Systemic diseases associated with non-arteritic anterior ischemic optic neuropathy. Am J Ophthalmol 118:766–780
Beri M, Klugman MR, Kohler JA, Hayreh SS (1987) Anterior ischemic optic neuropathy VII. Incidence of bilaterality and various influencing factors. Ophthalmology 94:1020–1028
Lubow M, Makley TA (1971) Pseudopapilledema of juvenile diabetes mellitus. Arch Ophthalmol 85:417–422
Vaphiades MS (2002) The disk edema dilemma. Surv Ophthalmol 47:183–188
Hayreh SS (1996) Acute ischemic disorders of the optic nerve: pathogenesis, clinical manifestations and management. Ophthalmol Clin North Am 9:407–442
Hayreh SS, Zimmerman B (2005) Visual field abnormalities in nonarteritic anterior ischemic optic neuropathy: Their pattern and prevalence at the initial presentation. Arch Ophthalmol 123:1554–1562
Hayreh SS, Zimmerman MB (2007) Non-arteritic anterior ischemic optic neuropathy-Natural history of visual outcome. Ophthalmology Aug 13 [Epub ahead of print]
Hayreh SS, Zimmerman MB, Podhajsky P, Alward WLM (1994) Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol 117:603–624
Hayreh SS, Podhajsky PA, Zimmerman B (1999) Role of nocturnal arterial hypotension in optic nerve head ischemic disorders. Ophthalmologica 213:76–96
Hayreh SS, Podhajsky PA, Zimmerman B (1997) Non-arteritic anterior ischemic optic neuropathy—time of onset of visual loss. Am J Ophthalmol 124:641–647
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hayreh, S.S. Role of retinal hypoxia in diabetic macular edema: a new concept. Graefes Arch Clin Exp Ophthalmol 246, 353–361 (2008). https://doi.org/10.1007/s00417-007-0678-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-007-0678-2