Review Article Open Access Diabetes & Metabolism Oluleye, J Diabetes Metab 2011, S:3 http://dx.doi.org/10.4172/2155-6156.S3-001 Special Issue 3 • 2011 J Diabetes Metab ISSN:2155-6156 JDM, an open access journal Introduction Diabetic Mellitus is now considered a pandemic disease. e World Health Organization reported that about 195 million people worldwide suﬀer from diabetes and that about two third of them are in the developing countries [1] By the year 2030, the number of people living with the disease will be more than double [2]. In the past, diabetes was thought to be foreign, but now, there is a global trend towards increase of the incidence and prevalence of diabetes in Africans [3]. Diabetic retinopathy is a major cause of blindness in the developed world. However, the changing lifestyle of people in developing countries is bringing this disease to the fore. Diabetic retinopathy is now a signiﬁcant cause of blindness in developing countries such as India [4] and Nigeria [5,6]. Diabetic Maculopathy Majority of diabetic maculopathy occur in Non Insulin Dependent Diabetes Mellitus (NIDDM) [7], Macular ischemia is more frequent in Insulin Dependent Diabetes Mellitus (IDDM) [8], aﬅer 20 years of known diabetes, the prevalence of diabetic macular edema (DME) is approximately 28% in both type 1 and type 2 diabetes [9]. Diabetic maculopathy consist of macular edema and ischemia. e edema occur as a result of breakdown in blood retinal barrier at the level of the perifoveal vessels. It consists of non- clinically signiﬁcant macular edema, clinically signiﬁcant macular edema which could be focal or diﬀuse. e use of Optical Coherence Tomography will further help in classifying into spongiform, foveal detachment and vitreo macular traction. Diabetic Macular edema (DME) is the leading cause of moderate visual loss in people with diabetes. Visual loss from DME is ﬁve times more than that from proliferative diabetic retinopathy (PDR) [7]. Pathophysiology of diabetic macular edema [10] e pathophysiology of diabetic macular edema is explained by micro angiopathies that occur in diabetics. is includes retinal microvascular change, thickening of retinal capillary basement membranes and reduction in the number of pericytes. ere is loss of autoregulation, increased permeability, incompetence of retinal vasculature and edema. e above mechanisms produce impaired oxygen diﬀusion, which stimulate the production of vascular endothelial growth factor (VEGF) [11]. VEGF may induce retinal vascular permeability through phosphorylation of the tight junctional protein occludin, resulting in the dissolution of the junctional complex [12]. Other pathogenetic mechanisms include endothelial cell apoptosis and retinal endothelial cell intercellular adhesion molecule-1 and CD 18 induced Inﬂammation. All the above mechanisms results in retinal vascular permeability and compromise of blood-retinal barrier leading to leakage of ﬂuid and plasma constituents in the surrounding retina especially in diﬀuse macular edema (Figure 1, 2). Macular ischemia Macular ischemia is a devastating condition that causes irreversible visual loss. It occur more in type I diabetes [13] Pathogenesis of macular Ischemia include basement membrane thickening, increased viscosity of blood and endothelial cell damage. is result in closure of perifoveal capillaries as evidenced by irregular widening of fovea avascular zone (FAZ) and budding of capillaries into FAZ on fundus ﬂourescein angiography ( FFA) (Figure 3). Diagnosis of diabetic maculopathy Clinical examination of the retina with the slit lamp biomicroscopy using the 78 or 90 diopter non contact fundus lens will show retinal elevation and swelling. is method of examination oﬀer stereoscopic and magniﬁed view of the retina. Fundus ﬂourescein angiography Corresponding author: Oluleye TS, Senior Lecturer, Consultant vitreo retinal surgeon, Retinal Unit, Department of Ophthalmology, University College Hospital, Ibadan, Nigeria, E-mail: t_oluleye@yahoo.co.uk Received July 30, 2011; Accepted September 30, 2011; Published November 25, 2011 Citation: Oluleye TS (2011) Current Management of Diabetic Maculopathy. J Diabetes Metab S3:001. doi:10.4172/2155-6156.S3-001 Copyright: © 2011 Oluleye TS. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Current Management of Diabetic Maculopathy Oluleye TS Retinal Unit, Department of Ophthalmology, University College Hospital, Ibadan, Nigeria Figure1: Clinically signiﬁcant macular edema (Hard exudates and edema within 500microns to center of fovea). Figure 2: Hard exudates and diffuse macular edema, fundus ﬂourescein angiography showing diffuse leakage and cystoids macular edema.