title: Diabetic glomerulosclerosis can be the pathogenesis of refractory diabetic macular edema.
abstract: BACKGROUND
  Kidney failure provoked by glomerulosclerosis leads to fluid filtration deficits and other disorders of kidney function. Refractory diabetic macular edema (DME) can be another warning sign of glomerulosclerosis in diabetic patients.
  
  
  METHODS
  A 40-year-old Saudi male presented with macular edema that was refractory to all possible medical and surgical ophthalmic interventions in both eyes. The macular edema significantly improved once the patient began systemic treatment for newly diagnosed diabetic glomerulosclerosis. This case report is presented with optical coherence tomography (OCT) documentation of before and after each medical and surgical intervention.
  
  
  METHODS
  Considerable improvement occurred after treatment with a systemic angiotensin-converting enzyme inhibitor and diuretic treatment due to newly diagnosed diabetic glomerulosclerosis.
  
  
  CONCLUSIONS
  Refractory DME can be secondary to diabetic glomerulosclerosis. This case indicates the possibility that systemic intervention may be warranted in cases of refractory DME, and the importance of collaboration between ophthalmologists, endocrinologists, and internists in these cases.
authors.affiliation: King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
authors.forename: Eman Saeed Al
authors.initials: ES
authors.lastname: Kahtani
keywords: angiotensin-converting enzyme inhibitor; diuretic; proteinuria