In diabetic retinopathy, the ETDRS (Early Treatment Diabetic Retinopathy Study) defined 'clinically significant macular edema' (CSME) using which criteria that still guide treatment decisions?
- A Any hard exudates within 2 disc diameters of the fovea
- B Any retinal thickening within 1 disc diameter of the fovea
- C Retinal thickening involving the foveal center visible on slit-lamp biomicroscopy only
- D Retinal thickening at or within 500 microns of foveal center; hard exudates at or within 500 microns with adjacent retinal thickening; or retinal thickening ≥1 disc area within 1 disc diameter of fovea ✓
Explanation
The ETDRS defined CSME using three criteria (any one sufficient): (1) retinal thickening at or within 500 microns of the foveal center; (2) hard exudates at or within 500 microns of foveal center with adjacent retinal thickening; (3) a zone of retinal thickening ≥1 disc area, any portion of which lies within 1 disc diameter of the foveal center. The ETDRS showed that focal/grid laser for CSME reduced the risk of moderate visual loss by 50%. While anti-VEGF agents (ranibizumab, bevacizumab, aflibercept) have now become first-line for center-involving DME, the CSME definition remains clinically relevant.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.