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Diffuse diabetic macular edema: pathology and implications for surgery.

Diffuse diabetic macular edema represents a common problem in diabetic patients. It is characterized by widespread and poorly demarcated leakage in the macular area. The vitreomacular interface in eyes with diffuse diabetic macular edema is composed of (1) a layer of native vitreous collagen covering the internal limiting membrane, (2) fibroblasts and fibrous astrocytes embedded in native vitreous collagen, and (3) mostly multilayered cellular membranes situated on a layer of vitreous collagen in eyes with tangential vitreomacular traction. Given the poor response of diffuse diabetic macular edema to grid laser photocoagulation, vitreoretinal surgical techniques including removal of the vitreous cortex and the internal limiting membrane of the retina have been proposed. In this chapter, the pathology of diffuse diabetic macular edema and the implications for surgery are discussed.