Guías de práctica clínica de la SERVManejo de las complicaciones oculares de la diabetes. Retinopatía diabética y edema macular

  1. Alicia Cristina Pareja Ríos
  2. Miguel Ángel Serrano García
  3. D. Marrero Saavedra
  4. Maximino Abraldes López-Veiga
  5. Miguel Ángel Reyes Rodríguez
  6. Francisco Cabrera López
  7. M. Isabel López Gálvez
  8. Pedro Ignacio Cardona Guerra
  9. Pedro Abreu Reyes
  10. E. Quijada Fumero
  11. A. Coronado Toural
  12. Estanislao Gutiérrez Sánchez
  13. María Antonia Gil Hernández
  14. P. Valls de Quintana
  15. Rafael Navarro Alemany
  16. F. Marín Olmos
Archivos de la Sociedad Española de Oftalmologia

ISSN: 0365-6691

Year of publication: 2009

Volume: 84

Issue: 9

Pages: 429-450

Type: Article

DOI: 10.4321/S0365-66912009000900003 DIALNET GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Archivos de la Sociedad Española de Oftalmologia


Cited by

  • Dimensions Cited by: 10 (12-04-2023)

SCImago Journal Rank

  • Year 2009
  • SJR Journal Impact: 0.215
  • Best Quartile: Q3
  • Area: Ophthalmology Quartile: Q3 Rank in area: 68/108


(Data updated as of 12-04-2023)
  • Total citations: 10
  • Recent citations: 3
  • Relative Citation Ratio (RCR): 0.19
  • Field Citation Ratio (FCR): 1.78


Objective: Diabetes mellitus is considered the most common cause of blindness in the working population of industrialized countries, with diabetic macular edema being the most common cause of decreased visual acuity and proliferative diabetic retinopathy (PDR) being responsible for the most severe visual deficits. We have therefore tried to establish a guide for clinical intervention whose purpose is to provide orientation on the treatment of diabetic retinopathy and its complications. This is necessary at a time when many treatment options have emerged whose role is not yet fully defined. Method: A group of expert retina specialists selected by the SERV (Vitreous-Retina Spanish Society) assessed the published results of different treatment options currently available, suggesting lines of action according to the degree of diabetic retinopathy present and the presence or absence of macular edema. Results: PDR is primarily treated with pan-retinal photocoagulation. For clinically significant diabetic macular edema without signs of vitreomacular traction, the treatment of choice continues to be focal/grid photocoagulation. Similarly, retinovitreal surgery is indicated for both conditions. The use of antiangiogenic drugs was also analyzed but remains inconclusive. Conclusion: Laser therapy is effective in the management of diabetic retinopathy and diabetic macular edema. The role of antiangiogenics is not yet sufficiently defined.

Bibliographic References

  • Bloomgarden, TZ. (2008). Diabetic retinopathy. Diabetes Care. 31. 1080-1083
  • (1991). Grading diabetic retinopathy from stereoscopic color fundus photographs: an extension of the modified Airlie House classification. ETDRS report number 10. Ophthalmology. 98. 786-806
  • Wilkinson, CP, Ferris, FL 3rd, Klein, RE, Lee, PP, Agardh, CD, Davis, M. (2003). Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 110. 1677-1682
  • (1995). Focal photocoagulation treatment of diabetic macular edema: Relationship of treatment effects to fluorescein angiographic and other retinal characteristics at baseline: ETDRS report no. 19. Arch Ophthalmol. 113. 1144-1155
  • Sander, B, Larsen, M, Engler, C, Strom, C, Moldow, B, Larsen, N. (2002). Diabetic macular oedema: a comparison of vitreous fluorometry, angiography, and retinopathy. Br J Ophthalmol. 86. 316-320
  • Zein, WM, Noureddin, BN, Jurdi, FA, Schakal, A, Bashshur, ZF. (2006). Panretinal photocoagulation and intravitreal triamcinolone acetonide for the management proliferative diabetic retinopathy with macular edema. Retina. 26. 137-142
  • Kumar, A, Sinha, S, Azad, R, Sharma, YR, Vohra, R. (2007). Comparative evaluation of vitrctomy and dye-enhanced ILM peel with grid laser in diffuse diabetic macular edema. Graefes Arch Clin Exp Ophthalmol. 245. 360-368
  • Lee, CM, Olk, RJ. (1991). Modifies grid laser photocoagulation for diffusse diabetic macular edema: Long term visual results. Ophthalmology. 98. 1594-1602
  • Lee, CM, Olk, RJ, Akduman, L. (2000). Combined modified grid and panretinal photocoagulation for diffusse diabetic macular edema and proliferative diabetic retinopathy. Ophthalmic Surg Lasers. 31. 292-300
  • Akduman, L, Olk, RJ. (1999). Subthreshold (invisible) modified grid and diodo laser photocoagulation in diffusse diabetic macular edema (DDME). Ophthalmic Surg Lasers. 30. 706-714
  • Akduman, L, Olk, RJ. (1997). Laser photocoagulation of diabetic macular edema. Ophthalmic Surg Lasers. 28. 387-408
  • Panozzo, G, Parolini, B, Gusson, E, Mercanti, A, Pinackatt, S, Bertoldo, G. (2004). Diabetic macular edema: an OCT-based classification. Semin Ophthalmol. 19. 13-20
  • (2008). Diabetes Care. 31. 1-2
  • Olafsdóttir, E, Stefánsson, E. (2007). Biennial eye screening in patients with diabetes without retinopathy: 10-year experience. Br J Ophthalmol. 91. 1599-1601
  • (1995). Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications Trial. Ophthalmology. 102. 647-661
  • (2003). Retinopathy and nephropathy in patients with type 1 diabetes four year after a trial of intensive therapy. N England J Med. 42. 381-389
  • (1995). The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the diabetes control and complications trial. Diabetes. 44. 968-983
  • (1993). The effect of intensive treatment of diabetes on development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 329. 977-986
  • (1998). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS33). Lancet. 352. 837-853
  • (1998). Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 317. 703-713
  • Verdaguer Tarradella, J. (2006). Retinopatía diabética: Tratado médico quirúrgico. Mac Line. Madrid.
  • Shimura, M, Yasuda, K, Nakazawa, T, Kano, T, Ohta, S, Tamai, M. (2003). Quantifying alterations of macular thickness before and after panretinal photocoagulation in patients with severe diabetic retinopathy and good vision. Ophthalmology. 110. 2386-2394
  • Sothornwit, N. (2008). Intravitreal bevacizumab for ahmed glaucoma valve implantation in neovascular glaucoma: a case report. J Med Assoc Thai. 91. 162-165
  • Mason, JO 3rd, Yunker, JJ, Vail, R, McGwin, G Jr. (2008). Intravitreal bevacizumab (Avastin) prevention of panretinal photocoagulation-induced complications in patients with severe proliferative diabetic retinopathy. Retina. 28. 1319-1324
  • Laser-Ranibizumab-Triamcinolone for Proliferative Diabetic Retinopathy (LRTforDME+PRP).
  • Álvarez López, A, Canut Jorda, MI. (2008). Estudio de bevacizumab (Avastin) intravítreo en el tratamiento del glaucoma neovascular. Anales Instituto Barraquer. 37. 75-85
  • Ruiz-Moreno, JM, Montero, JA, Lugo, F, Amat, P, Staicu, C. (2008). Intravitreal bevacizumab in recurrent diabetic vitreous haemorrhage after vitrectomy. Acta Ophthalmol. 86. 231-232
  • Jonas, JB, Libondi, T, von Baltz, S, Vossmerbaeumer, U. (2008). Intravitreal bevacizumab for vitreous haemorrhage. Acta Ophthalmol. 86. 585-586
  • Spaide, RF, Fisher, YL. (2006). Intravitreal bevacizumab (Avastin) treatment of proliferative diabetic retinopathy complicated by vitreous hemorrhage. Retina. 26. 275-278
  • Arévalo, F, Alfaro, V, García, RA, Fernández, CF. (2006). Retinopatía diabética: Tratado médico quirúrgico. MacLine. Madrid.
  • Ruiz-Moreno, JM, Montero, JA, Lugo, F, Amat, P, Staicu, C. (2008). Intravitreal bevacizumab in recurrent diabetic vitreous haemorrhage after vitrectomy. Acta Ophthalmol. 86. 231-232
  • Berrocal, MH. (2006). Retinopatía diabética: Tratado médico quirúrgico. MacLine. Madrid.
  • Engelbert, M, Del Priore, L, Al-Aswad, A. (2008). Neovascular Glaucoma. Contemporary Ophthalmology. 7. 15
  • Hong, C, Arosemena, A, Zurakowowski, D, Ayyala, RS. (2005). Glaucoma drainage devices: a sistematic literature review and current controversies. Diagnostic and surgical techniques. Surv Ophthalmol. 50. 48-60
  • Ichhpujani, P, Ramasubramanian, A, Kaushik, S, Pandav, S. (2007). Bevacizumab in glaucoma: a review. Can Ophthalmol. 42. 812-815
  • Mirshahi, A, Roohipoor, R, Lashay, A, Mohammadi, SF, Abdoallahi, A, Faghihi, H. (2008). Bevacizumab-augmented retinal laser photocoagulation in proliferative diabetic retinopathy: a randomized double-masked clinical trial. Eur J Ophthalmol. 18. 263-269
  • Schlote, T, Derse, M, Rassmann, K, Nicaeus, T, Dietz, K, Thiel, HJ. (2001). Efficacy and safety of contact transscleral diode laser cyclophotocoagulation for advanced glaucoma. J Glaucoma. 10. 294-301
  • Miki, A, Oshima, Y, Otori, Y, Kamei, M, Tano, Y. (2008). Efficacy of intravitreal bevacizumab as adjunctive treatment with pars plana vitrectomy, endolaser photocoagulation, and trabeculectomy for neovascular glaucoma. Br J Ophthalmol. 92. 1431-1433
  • Kitnarong, N, Chindasub, P, Metheetrairut, A. (2008). Surgical outcome of intravitreal bevacizumab and filtration surgery in neovascular glaucoma. Adv Ther. 25. 438-443
  • (2008). European Glaucoma Society Terminology and guidelines for glaucoma. Dogma.
  • Jurecka, T, Bátková, Z, Ventruba, J, Synek, S. (2007). Macular edema after cataract surgery in diabetic patients without retinopathy. Cesk Slov Oftalmol. 63. 274-284
  • Macugen to prevent worsening of macular edema following cataract surgery in diabetics.
  • Triamcinolona.
  • Estabrook, EJ, Madhusudhana, KC, Hannan, SR, Newsom, RS. (2007). Can optical coherence tomography predict the outcome of laser photocoagulation for diabetic macular edema?. Ophthalmic Surg Lasers Imaging. 38. 478-483
  • Kaderli, B, Avci, R, Gelisken, O, Yucel, AA. (2005). Intravitreal triamcinolone as an adjunct in the treatment of concomitant proliferative diabetic retinopathy and diffuse diabetic macular edema: combined IVTA and laser treatment for PDR with CSMO. Int Ophthalmol. 26. 207-214
  • Lida, T. (2007). Combined triamcinolone acetonide injection and grid laser photocoagulation: a promising treatment for diffuse diabetic macular edema?. Br J Ophthalmol. 91. 407-408
  • Shimura, M, Nakazawa, T, Yasuda, K, Shiono, T, Nishida, K. (2007). Pretreatment of posterior subtenon of triamcinolone acetonide has beneficial effects for gird pattern photocoagulation against diffuse diabetic macular oedema. Br J Ophthalmol. 91. 449-454
  • Kang, SW, Sa, HS, Cho, HY, Kim, JL. (2006). Macular gird photocoagulation after intravitreal triamcinolone acetonide for diffuse diabetic macular edema. Arch Ophthalmol. 124. 653-658
  • Haritoglou, C, Kook, D, Neubauer, A, Wolf, A, Priglinger, S, Strauss, R. (2006). Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema. Retina. 26. 999-1005
  • Cabrera López, F, Cabrera Marrero, B, Baeta Bayón, L, Jerez Olivera, E, Cardona Guerra, P. (2005). Actualización en el diagnóstico y tratamiento del edema macular diabético. Arch Soc Can Oftalmol. 16. 69-82
  • Lewis, H, Abrams, GW, Blumenkranz, MS, Campo, RV. (1992). Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction. Ophthalmology. 99. 753-759
  • Harbour, JW, Smiddy, WE, Flynn, HW Jr, Rubsamen, PE. (1996). Vitrectomy for diabetic macular edema associated with thickened and taut posterior hyaloid membrane. Am J Ophthalmol. 121. 405-413
  • Gandorfer, A, Messmer, EM, Ulbig, MW, Kampik, A. (2000). Resolution of diabetic macular edema after surgical removal of than posterior hyaliod and the inner limiting membrane. Retina. 20. 126-133
  • Avic, R, Karderli, B, Avic, B, Simsek, S, Baykara, M, Kahveci, Z. (2004). Pars plana vitrectomy and removal of the internal limiting membrane in the treatment of chronic macular edema. Graefes Arch Clin Exp Ophthalmol. 242. 845-852
  • Recchia, FM, Ruby, AJ, Recchia, CA. (2005). Pars plana vitrectomy with removal of the internal limiting membrane in the treatment of persistent diabetic macular edema. Am J Ophthalmol. 139. 447-454
  • Pendergast, SD, Hassan, TS, Williams, GA, Cox, MS, Margherio, RR, Ferrone, PJ. (2000). Vitrectomy for diffuse diabetic macular edema associated with taut premacular posterior hyaloid. Am J Ophthalmol. 130. 178-186
  • Lövestam-Adran, M, Larsson, J. (2005). Vitrectomy seems to be beneficial for advanced diffuse diabetic macular oedema not responding to laser treatment. Int Ophthalmol. 26. 21-26
  • Matsumoto, H, Yamanaka, I, Hisatomi, T, Enaida, H, Ueno, A, Hata, Y. (2007). Triamcinolone assisted pars plana vitrectomy improves residual posterior vitreus hyaloid removal: ultrastructural analysis of the inner limiting membrane. Retina. 27. 174-179
  • Bahadir, M, Ertan, A, Mertoglu, O. (2005). Visual acuity comparision of vitrectomy with and without internal limitig membrane removal in the treatment of diabetic macular edema. Int Ophthalmol. 26. 3-8
  • Patel, JI, Hykin, PG, Schadt, M, Luong, V, Fitzke, F, Gregor, ZJ. (2006). Pars plana vitrctomy with and without peeling of the inner limiting membrane for diabetic macular edema. Retina. 26. 5-13
  • Aboutable, T. (2006). Is removal of internal limiting membrane always necessary during surgery for refractory diffuse diabetic macular edema without evident epimacular proliferation?. Klin Mmonatsbl Augenheilkd. 223. 681-686
  • Meyer, CH. (2007). Current treatment approaches in diabetic macular edema. Opthalmologica. 221. 118-131
  • Browning, DJ, Fraser, CM, Powers, ME. (2006). Comparison of the magnitude and time course of macular thinning induced by different interventions for diabetic macular edema: implications for sequence of application. Ophthalmology. 113. 1713-1719
  • Yanyali, A, Nohutcu, AF, Horozoglu, F, Celik, E. (2005). Modified grid laser photocoagulation versus pars plana vitrectomy with internal limiting membrane removal in diabetic macular edema. Am J Ophthalmol. 139. 795-801
  • Jonas, JB. (2006). Intravitreal triamcinolone acetonide: a change in paradigm. Ophthalmic Res. 38. 218-245
  • Jonas, JB, Degenring, RF, Kreissig, I, Akkoyun, I, Kampeter, BA. (2006). Intraocular pressure elevation after triamcinolone acetonide injection. Ophthalmology. 112. 593-598
  • Kreissig, I, Degenring, RF, Jonas, JB. (2005). Diffuse diabetic macular edema: Intraocular pressure after intravitreal triamcinolone acetonide. Ophthalmologe. 102. 153-157
  • Jonas, Kreissig I, Budde, WM, Degenring, RF. (2005). Cataract surgery combined with intravitreal triamcinolone acetonide. Eur J Ophthalmol. 15. 329-335
  • Chin, HS, Park, TS, Moon, YS, Oh, JH. (2005). Difference in clearance of intravitreal triamcinolone acetonide between vitrectomized and nonvitrectomized eyes. Retina. 25. 556-560
  • Jonas, JB. (2005). Intravitreal triamcinolone acetonide for treatment of intraocular oedematous and neovascular diseases. Acta Ophthalmol Scand. 83. 645-663
  • Spandau, UH, Derse, M, Schmiz-Valckemberg, P, Papoulis, C, Jonas, JB. (2005). Dosage dependency of intravitreal triamcinolone acetonide as treatment of diabetic macular oedema. Br J Ophthalmol. 89. 999-1003
  • Gibran, SK, Cullinae, A, Jungkim, S, Cleary, PE. (2000). Intravitreal triamcinolone for diffuse diabetic macular edema. Eye. 20. 720-724
  • Jonas, JB, Degenring, RF, Kamppeter, BA, Kreissig, I, Akkoyun, J. (2004). Duration of the effect of intravitreal triamcinolone acetonide as treatment for diffuse diabetic macular edema. Am J Ophthalmol. 138. 158-160
  • A Multicentre Randomised Clinical Trial of Laser Treatment Plus Intravitreal Triamcinolone for Diabetic Macular Oedema.
  • Efficacy and Safety Study of Intravitreal Triamcinolone to Treat Diffuse Diabetic Macular Edema.
  • Laser-Ranibizumab-Triamcinolone for Diabetic Macular Edema (LRT for DME).
  • Tachi, N, Ogino, N. (1996). Vitrectomy for diffuse diabetic macular edema in cases of diabetic retinopathy. Am J Ophthalmol. 122. 258-260
  • Otani, T, Kishi, S. (2002). A cotrolled study of vitrectomy for diabetic macular edema. Am J Ophthalmol. 134. 214-219
  • Figueroa, MS, Contreras, I, Noval, S. (2008). Surgical and anatomical outcomes of pars plana vitrectomy for diffuse nontractional diabetic macular edema. Retina. 28. 420-426
  • Hartley, KL, Smiddy, WE, Flynn, HW Jr, Murray, TG. (2008). Pars plana vitrectomy with internal limiting membrane peeling for diabetic macular edema. Retina. 28. 410-419
  • Avitabile, T, Longo, A, Reibaldi, A. (2005). Intravitreal triamcinolone compared with macular laser grid photocoagulation for the treatment of cystoid macular edema. Am J Ophthalmol. 140. 695-698
  • (2008). A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology. 115. 1447-1449
  • Ho, TC, Lai, WW, Lam, DS. (2006). Intravitreal triamcinolone compared with macular laser grid photocoagulation for the treatment of cystoid macular edema. Am J Ophthalmol. 141. 786-787
  • Chung, EJ, Roh, MI, Kwon, OW, Koh, HJ. (2008). Effects of macular ischemia on the outcome of intravitreal Bevacizumab therapy for diabetic macular edema. Retina. 28. 957-963