**5. OCT classification of macular edema**

Along with the development of OCT imaging, various classifications of DME have been elaborated. The first OCT classification of DME belongs to Otani, and it is based on morphological


**Table 3.** OCT classification of macular edema (after Koleva-Georgieva).

parameters, into three categories: sponge-like swelling, cystoid edema and serous retinal detachment [5]. A fourth category was added by Trichonas et al., posterior hyaloid traction (PHT) [6]. A more detailed classification was proposed by Koleva-Georgieva, and it is based on quantitative and qualitative OCT data: retinal thickness, retinal morphology, retinal topography, macular traction, foveal photoreceptor status (**Table 3**) [8].

treatment in the stage of mild edema had positive outcome. In OS, the high degree of macular

**Figure 1.** OD diffuse mild thickening of the macular region. OS large ovoid spaces of low reflectivity (liquid content) separated by hyperreflective septae located in the neurosensitive retina that represent intraretinal cystoid-like cavities; hyperreflective deposits with posterior shadowing (hard exudates, hemorrhages) in the neurosensory retina; no evidence of PHT; significant increase of the macular thickness, mainly centrally—on the account of the cystoids cavities.

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In this case, intravitreal anti-VEGF injections alone would probably not lead to the resolution of edema, because vitreo-macular traction is also involved in its pathophysiology. Therefore, pars plana vitrectomy with dissection of the posterior hyaloid from the macular area was

In this case, anti-VEGF injections are indicated in AO, but with a much better prognosis in LE where edema is mild, as compared to RE in which the macula is disorganized (**Figures 5**

In this case, beside anti-VEGF injections, pars plana vitrectomy appears reasonable in order to

Even if macular edema is mild, intravitreal anti-VEGF would prevent its progression toward

On the ground of the OCT aspect, intravitreal anti-VEGF injections are indicated in OD, but

disorganization prevented a significant improvement in vision (**Figure 2**).

release the traction exerted by the posterior hyaloid on the macula.

not in LE in which retinal atrophy is present (**Figure 8**).

more advanced stages with cystoid degeneration of the macula (**Figure 7**).

indicated (**Figures 3** and **4**).

and **6**).
