TREATMENT OF DIABETIC MACULAR EDEMA WITH DETACHMENT OF THE NEUROEPITHELIUM WITH HIGH-DOSE CORTICOSTEROID-THERAPY AND PHOTOCOAGULATION

The clinical course of background diabetic retinopathy in its oedemato us form (macular and diffuse posterior pole edema), leads to serous ma cular retinal detachment. At this stage, even if the laser burns are o bserved on the retinal pigment epithelium, laser photocoagulation is u nsuccessful in such a serous detachment, because retinal neuroepitheli um is far from the retinal pigment epithelium. We have previously noti ced that high doses of oral steroid drug (one milligram per kilo a day ) for fifteen days may allow a partial or complete macular flattening. This flattening is only correctly evaluated by contact glass biomicro scopy, and often associated to a visual improvement. Favourable outcom e was observed in 76 % of the fifty-eight eyes, which have been laser treated. When laser photocoagulation was successful, the results were stable with an improvement of two or four lines. If flattening did not occur, laser photocoagulation was not performed. Oral steroids treatm ent for long-term insulinotreated diabetic patients required a very cl ose daily diabetic or/and internist surgery. At our institution, it wa s possible because the internist was at the patient's bed once or twic e a day:for this reason, this technique seems to be the first study in literature. Some very unexpected visual improvements incite us to use classic laser treatment as early as possible for macular or diffuse p osterior pole oedema, before a serous retinal detachment occurs and re nders treatment impossible excepted with the help of high doses steroi ds.