2 containing xanthophyll (yellow) pigment. Macula defined by anatomists as the macula lutea, or yellow spotcontaining xanthophyll (yellow) pigment.area with 2 or more layers of ganglion cells that is 5-6 mm in diametercentered vertically between the temporal vascular arcades
4 Anatomy of maculaThe central 1.5 mm within the macula is occupied by the fovea (or fovea centralis),Within the fovea is a region devoid of retinal vessels known as the foveal avascular zone (FAZ).The geometric center of the FAZ is a central pit known as the foveola, (0.35 mm)Surrounding the fovea is a ring 0.5 mm in diameter, called the parafoveal area where the ganglion cell layer, inner nuclear layer and outer plexiform layer are thickest. Surrounding this zone, a ring approximately 1.5mm wide is termed the perifoveal zone
5 Macular EdemaMacular edema occurs when fluid and protein deposits collect on or under the macula of the eye a yellow central area of the retinacausing it to thicken and swell. The swelling may distort a person's central vision,Cystoid macular edema is a type of macular edema that includes cyst formation.
6 Macular EdemaClinically significant macular edema (CSME), is used in diabetic retinopathyCystoid macular edema (CME)Irvine gass syndrum (CME) is used after after cataract surgeryMacular cyst: degenerative, Tractional, radiationalCentral serous retinopathy (CSR)Choroidal neovascular membrane (CNVM)Retinal pigment epithelium detachement (PED)
10 Clinically significant macular edema CSME: Hard exudates at or within 500 u of the center of the macula if associated with thickening of the adjacent retina.CSME: Retinal edema located ator within 500 u of the center of the macula.CSME: A zone of thickening larger than 1 disc area if located within 1 disc diameter of the center of the macula.
11 Clinically Significant Macular Edema (CSME) is usually associated with diabetes mellitus (DM). It is the most common cause of visual acuity loss with DM
12 Left – macular thickening from CSME (note the red central zone of the thickness map). Right – normal macular thickness.
13 Diabetic Macular Edema May present as noncystoid or cystoid macular edema
24 Macular Edema Cystoid macular edema (CME) Clinically significant macular edema (CSME), is used in diabetic retinopathyCystoid macular edema (CME)Irvine gass syndrum (CME) is used after after cataract surgeryMacular cyst: degenerative, Tractional, radiationalCentral serous retinopathy (CSR)Choroidal neovascular membrane (CNVM)Retinal pigment epithelium detachement (PED)
25 Cystoid Macular Edema: Cystoid macular edema (CME) is characterized by intraretinal edema contained in honeycomb-like cystoid spaces.Fluorescein angiography shows the source of edema to be abnormal perifoveal retinal capillary permeability seen as multiple smallfocal fluorescein leakages.
32 Causes of CME based on presence or absence of vascular leakage CME WITH RETINAL VASCULAR LEAKAGEDiabetic retinopathyRetinal vein occlusionPseudophakia or aphakiaIdiopathic retinal telangiectasiaUveitisCME WITHOUT RETINAL VASCULAR LEAKAGECertain types of retinitis pigmentosaEarly stages of macular holeNicotinic acid maculoipathy With choroidal neovascularization
34 Intravitreal triamcinolone and bevacizumab combination therapy for macular edema due to central retinal vein occlusion refractory to either treatment aloneThere is profound intra-retal and sub-retinal fluid
35 Intravitreal triamcinolone and bevacizumab combination therapy for macular edema due to central retinal vein occlusion refractory to either treatment alone.There is no intra-retinal or sub-retinal fluid
46 Retinal pigment epithelial detachment (hidden on the angiogram) choroidal neovascular membrane. three Lucentis injections over a 6 month period.
47 The OCT image directly above is a scan of the same eye 6 months after the first Lucentis treatment. Notice the dramatic reduction of fluid. Also notice that scar tissue remains (the red-orange intra-retinal area). Visual acuity started at 20/50, reduced to 20/100 at the 3 month interval, and then recovered to 20/50 at the time of the above OCT scan.
48 OCT image of a PED. The arrow points to the orange-red RPE layer, which has been pushed up by the fluid.
53 A lamellar macular hole may be a precursor to a full macular hole
54 Myopic degeneration. Left – retinal thinning revealing choroid, with myopic disc. Middle – OCT showing concave globe from posterior staphyloma. Right – myopic chorioretinal thinning, exposing the sclera.
55 Acute nuroretinitisLate phase FA right eye. Note large number of choroidal lesions and optic disc staining
59 Idiopathic juxtafoveal polypoidal chorioretinopathy Idiopathic juxtafoveal polypoidal chorioretinopathy. Left – unique spherical CNVMs as seen on fluorescein angiogram. Right – OCT of IJPC (above) with fundus orientation/fluorescein angiogram (below)
68 The new blood vessels leak blood and serous fluid from the blood into the sub-retinal spaces. (SRNVM) or choroidal neovascular membranes (CNV).
69 Fundus photo and an OCT image of a macular scar secondary to AMD.
70 Red-free photograph showing a subtle wedge-shaped dark lesion just above the centre of the fovea, pointing downwards. The vertical arrow shows the direction of the optical coherence tomography scan. (b) Optical coherence tomography image of the left eye, showing an area of retinal thinning (177 m in thickness, marked by the hollow arrow) corresponding to the lesion in (a). The solid arrow points to an area of normal retina (241 m).