Diabetic Macular Edema with Massive Hard Exudates

Massive amounts of hard exudates result from severe retinal vascular leakage and may significantly affect vision if they occur in the macular area (Yang, Retina 20:121–125, 2000; Kumagai et al., Retina 29:464–472, 2009; Ferris and Patz, Surv Ophthalmol 28 Suppl:452–461, 1984). Any disease that causes vascular leakage, including hypertension retinopathy, central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), Coats disease, radiation retinopathy, vessel occlusion from autoimmune diseases, etc., may cause the development of massive amounts of exudates. Hard exudates are lipids and proteinaceous materials that deposit within the neurosensory retina and in the subretinal space (Fong et al., Arch Ophthalmol 115:873–877, 1997). In DR, massive HE is always associated with severe diabetic macular edema (DME). Whether medical treatment involving IVI of anti-vascular endothelial growth factor (VEGF)/steroid agents or surgical treatment should be used to treat this condition has not been investigated in depth. The manifestations, indications for surgery, and surgical outcomes will be discussed in this chapter.