During an annual eye examination, a 65-year-old woman
with a 5-year history of type 2 insulin-dependent diabetes
complained that her vision had slightly worsened in both
eyes. Her best corrected visual acuity was 20/30 in both
Ophthalmoscopic examination revealed nonproliferative
diabetic retinopathy changes, including dot-blot hemorrhages
that originated in the middle layers of the retina.
Areas of yellow, waxy, hard exudates composed of lipoprotein
and lipid-filled macrophages were seen forming
clumps and circinate rings adjacent to and involving the
macula. Stereoscopic examination of the macula confirmed
macular thickening. No cotton-wool spots or areas of neovascularization
were noted (A and B).
Diabetic maculopathy was confirmed by a fluorescein
angiogram, which revealed leaking microaneurysms that
caused the retinal thickening and the hard exudates. A
focal argon laser treatment was performed in each eye to
resolve the macular edema, encourage resorption of leaked
fluid, and treat leaking vessels and microaneurysms to prevent
Laser treatment for clinically significant macular
edema is recommended if one or more of the following
findings is present:
Retinal edema (thickening) within 500 m of the center
of the fovea.
Hard exudates within 500 m of the fovea, if associated
with adjacent retinal thickening (which may be outside
the 500-m limit).
Retinal edema that is 1 disc area (1500 m) or larger, any
part of which is within 1 disc diameter of the center of the
This patient required only a single laser treatment.
Additional treatments can be given if complete resorption
is not achieved after 2 to 3 months.