Role of retinal hypoxia in diabetic macular edema: a new concept.
BACKGROUND
To report the role of retinal hypoxia in development of diabetic macular edema and its management--a new concept.


METHODS
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.
Hayreh
Sohan Singh
SS
Department of Ophthalmology & Visual Sciences, College of Medicine, University of Iowa, Iowa, IA, USA. Sohan-hayreh@uiowa.edu
D000328:Adult; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D003928:Diabetic Nephropathies / Q000188:drug therapy / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D000860:Hypoxia / Q000188:drug therapy / Q000503:physiopathology*; D007328:Insulin / Q000627:therapeutic use; D017706:Lisinopril / Q000627:therapeutic use; D008269:Macular Edema / Q000188:drug therapy / Q000503:physiopathology*; D018917:Optic Neuropathy, Ischemic / Q000188:drug therapy / Q000503:physiopathology; D000069583:Pregabalin; D011507:Proteinuria / Q000188:drug therapy / Q000503:physiopathology; D012164:Retinal Diseases / Q000188:drug therapy / Q000503:physiopathology*; D041623:Tomography, Optical Coherence; D014147:Tramadol / Q000627:therapeutic use; D014786:Vision Disorders / Q000503:physiopathology; D014792:Visual Acuity; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives / Q000627:therapeutic use
D007328:Insulin; D014147:Tramadol; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D017706:Lisinopril