**8. Importance of OCT in selecting the appropriate therapy for DME**

For many years, the only therapy of DME was laser photocoagulation which was indicated exclusively on clinical criteria, defined by Early Treatment Diabetic Retinopathy Study (ETDRS) as clinically significant macular edema [9]. Currently, therapeutic approaches of DME expanded, including anti-VEGF and steroid intravitreal injections and vitreo-retinal surgery [9]. The selection of the optimal therapy is correlated with the pathogeny of DME, which is best elucidated by OCT.

In most circumstances, DME is the consequence of internal blood-retinal barrier break-down with subsequent accumulation of fluid in the retina. Macular thickness and fluid topography are precisely evaluated by OCT. In these DME categories, the first line treatment is represented in our practice by intravitreal anti-VEGF injections. In refractory cases intravitreal steroids are considered.

OCT is the only method capable to identify and describe the aspect of the vitreoretinal interface. As such, within the DME group OCT individualizes a subgroup of patients with posterior hyaloid traction (PHT) which is often overlooked with fundus biomicroscopy. This particular form of DME is more resistant to medical therapy and vitreo-retinal surgery with membrane dissection is indicated. Intraoperative OCT is an important decision-making tool assisting the surgeon to identify the surgical planes and define the relationships of the membrane with the retina [9].

**Author details**

**References**

Simona Delia Nicoară

Address all correspondence to: simonanicoara1@gmail.com

In Tech; 2013. pp. 133-159. DOI: 10.5772/53357

Medicine and Pharmacy, Cluj-Napoca, Romania

survophthal.2012.10.002

bjophthalmol-2014-305305

10.1155/2013/434560

30302

2015;**6**:66-69

DOI: 274383296

Faculty of Medicine, Department of Ophthalmology, "Iuliu Hațieganu" University of

Ophthalmology. 2011;**25**(2):123-129. DOI: 10.1016/j.sjopt.2011.01.011

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Not only does OCT identify the causes of DME, but it also allows early diagnosis and treatment of DME, before it is clinically significant [10]. This is translated in the clinical practice by better anatomical and functional outcomes.

The moment of treatment emerges from the OCT aspect correlated with visual acuity. Generally, there is a parallel correspondence between the anatomical and functional data. However, if OCT shows a slight increase in central retinal thickness (CRT) but visual acuity is 20/20, the patient is watched closely, and treatment is promptly initiated if the visual function follows a negative trend [10].

Usually, the evolution of OCT aspect of the macula is parallel to the response of visual acuity. If the increase of visual acuity does not correspond to the improvement of OCT aspect, a long time evolution of DME and/or the use of multiple treatment modalities should be considered [10].
