The historical discovery of macular edema

The occurence of macular edema, or of intraretinal fluid in general, was la rgely unknown prior to the invention of the ophthalmoscope. One of the firs t reports on 'Retinitis in Glycosuria', a disease complex, which today woul d partly be described as diabetic maculopathy, was published in 1856 by Jae ger. His observations were confirmed less than twenty years later by Nettle ship in London, and in 1875 Appolinaire Bouchardat from Paris described flu id and lipid accumulation in the macula which led - in his words - to a glu cose induced amblyopia. The first pathophysiological hypotheses of fluid ac cumulation in the posterior pole were then put forward in 1882 by Tartuferi , who thought the edema represented swelling of photoreceptor sheaths. In 1 896, the Frenchman Nuel coined the term 'oedeme maculaire' which he had obs erved in a retinitis pigmentosa patient. However, it was not until the end of the first World War, that the Swiss ophthalmologist Alfred Vogt observed macular edema in a variety of other ocular conditions such as iridocycliti s or retinal vein occlusion as well as the progression from macular edema t o a macular hole. A quarter of a century later Bangerter coined the German term 'Zystoides Makulaodem', and in 1950, Hruby was the first to draw atten tion to the development of macular edema after cataract extraction. Three y ears later this was followed by Irvine's classical paper on cystoid macular edema after intra- and extracapsular cataract extraction which had been co mplicated by incarceration of the vitreous in the anterior segment with con secutive tugging on the macula. A decade later, the phenomenon of cystic fl uid accumulation in the macula after cataract extraction was further charac terised by Gass and Norton using fluorescein angiography. The ensuing years saw the emergence of new concepts regarding the blood-retinal barrier and the paramount role of its dysfunction in the development of macular edema.