[Treatment of diabetic macular edema with neuroepithelium detachment combining high-dose corticotherapy and photocoagulation].

The clinical course of background diabetic retinopathy in its oedematous form (macular and diffuse posterior pole edema), leads to serous macular retinal detachment. At this stage, even if the laser burns are observed on the retinal pigment epithelium, laser photocoagulation is unsuccessful in such a serous detachment, because retinal neuroepithelium is far from the retinal pigment epithelium. We have previously noticed that high doses of oral steroid drug (one milligram per kilo a day) for fifteen days may allow a partial or complete macular flattening. This flattening is only correctly evaluated by contact glass biomicroscopy, and often associated to a visual improvement. Favourable outcome was observed in 76% of the fifty-eight eyes, which have been laser treated. When laser photocoagulation was successful, the results were stable with an improvement of two or four lines. If flattening did not occur, laser photocoagulation was not performed. Oral steroids treatment for long-term insulin treated diabetic patients required a very close daily diabetic or/and internist survey. At our institution, it was possible because the internist was at the patient's bed once or twice a day: for this reason, this technique seems to be the first study in the literature. Some very unexpected visual improvements incite us to use classic laser treatment as early as possible for macular or diffuse posterior pole oedema, before a serous retinal detachment occurs and renders treatment impossible excepted with the help of high doses steroids.