The relation between visual acuity, fixation stability, and the size and location of foveal hard exudates after photocoagulation for diabetic maculopathy

Abstract

The retinal area covered by hard exudates decreases during the first 6 months after central photocoagulation, but increases again between 6 and 12 months after the treatment. Hard exudates covering the foveal region contribute to disturbance of central vision.

Binocular fixation topography in patients with diabetic macular oedema

“…We have previously hypothesised that change in fixation area after retinal photocoagulation for diabetic maculopathy could be related to retinal lesions such as hard exudates and retinal oedema [28]. In a recent study, we found that the location of fixation may change due to hard exudates covering the fovea, but the fixation area was not correlated to the size of the retinal area covered by hard exudates.…”

Using multifocal electroretinography hard exudates affect macular function in eyes with diabetic retinopathy

“…In addition to visual acuity measurement, studies on fixation stability [8] and fundus microperimetry [9] in eyes with hard exudates have demonstrated decreased fixation stability and reduced function above circinate rings. However, the direct influence of hard exudates on retinal function is not fully understood.…”

Short-Term Progression of Diabetic Hard Exudates Monitored with High-Resolution Camera

“…Bolz et al [9, 10] reported the existence of foci, deposits located within the walls of intraretinal microaneurysms that are scattered throughout all retinal layers, forming confluent plaques in the outer plexiform layer [11]. Various treatments including lipid-lowering agents [1], photocoagulation [4], surgical excision [12], intravitreal injections of steroids [13], or more recently, antiangiogenic agents [14, 15] have been proposed to promote their regression. Previous assessment using SD-OCT and/or retinography have shown HE regression after several months [4, 11], mostly by macrophage phagocytosis.…”

“…DME results from a breakdown of the blood-retina barrier of intraretinal vessels, leading to an enhanced lipid and protein exudation clinically labeled hard exudates (HEs) [2]. HEs are frequently associated with a high level of serum lipids [1, 3] and can contribute to visual loss when they are located in the foveal area [1, 4-6]. For years, retinography was the gold standard in assessing HE size on a set of standard stereoscopic color photographs as proposed by the Early Treatment Diabetic Retinopathy Study [1, 7, 8].…”

“…Various treatments including lipid-lowering agents [1], photocoagulation [4], surgical excision [12], intravitreal injections of steroids [13], or more recently, antiangiogenic agents [14, 15] have been proposed to promote their regression. Previous assessment using SD-OCT and/or retinography have shown HE regression after several months [4, 11], mostly by macrophage phagocytosis. Recently, a new imaging modality, adaptive optics (AO), based on the correction of the optical aberrations of the eye, has contributed new insight into the retinal imaging field by providing real-time images of the retinal structure a few microns in size such as photoreceptor cells, the vessel wall, or pigment migration [16-19].…”