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Case 50

Shaan Bhambra (McGill University Medical Student)

Patient Presentation: A 65-year-old male with known T2DM, treated with metformin and sitagliptin presents to your clinic. His last A1C was 8.6%. He presents with blurry vision over the past few months, as well as floaters. Fundus findings show dot blot heme bilaterally but greater in OD, and hyper-reflective foci suggesting exudates:


Question: What are the most notable abnormalities in the OCT image below, at each arrow?


Question: The macular OCT images of both eyes are shown above. What is the likely diagnosis?

Question: Early Treatment Diabetic Retinopathy Study (ETDRS) defines clinically significant macular edema as:

Question: Which is the most effective treatment for this diagnosis?


  1. Codenotti, M., Maestranzi, G., Prati, M. & Iuliano, L. Treatment of Hard Macular Exudates in Diabetic Retinopathy.

  2. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report no 1. Arch Ophthalmol. 1985;103:1796–1806.

  3. Sun, J. K. Intravitreal Anti-VEGF Therapy with Prompt or Deferred Laser Compared with Steroid with Prompt Laser and Prompt Laser Alone for Treatment of Diabetic Macular Edema. Curr Diab Rep 11, 227–229 (2011)



Learning Objectives:

  1. Recognize the key determinants in characterizing clinically significant macular edema.

  2. Recognize the treatment options for DME 

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