Macular complication: from edema to ischemia

The pathophysiology of macular complications in diabetic retinopathy is multifactorial. Diabetic macular edema and ischemia (both macular and peripheral) are the major drivers of macular involvement in diabetes. Macular edema may be both intra and extra-cellular and it is clinically characterized by different aspects, mainly detected by an accurate qualitative analysis of spectral domain OCT data. This approach allows to identify different phenotypes of diabetic macular edema, providing a track to a personalized treatment. Macular ischemia has always been considered a negative prognostic factor in the treatment of macular edema, and this aspect has been recently re-confirmed. Peripheral retinal ischemia, easily documented by wide field retinal angiography, is emerging as a “new” driver of macular edema. All these new aspects, better defined by a multimodal imaging approach, are the essential to plan an adequate treatment.