The Early Treatment Diabetic Retinopathy Study historical review and relevance to today's management of diabetic macular edema.

PURPOSE OF REVIEW: To provide an historical review of the Early Treatment Diabetic Retinopathy Study (ETDRS) in the management of diabetic macular edema (DME), and to discuss its relevance to the management of DME. RECENT FINDINGS: The ETDRS reported that argon laser treatment is beneficial in the management of 'clinically significant' DME. The study provided guidelines for the treatment with focal and/or grid laser based on fluorescein angiographic patterns. In today's world, with the advent of optical coherence tomography, 'clinically significant' DME is now classified into center-involved DME (CI DME) and noncenter-involved DME (non-CI DME). Modified ETDRS focal/grid laser photocoagulation has been utilized in more recent clinical trials [diabetic retinopathy clinical research (DRCR) Protocols I and T] in combination with intravitreal injections. SUMMARY: The ETDRS provided outcomes data for DME, both untreated and following laser therapy. In the management of patients with DME today, the modified ETDRS focal/grid laser photocoagulation treatments remain relevant in combination with anti-vascular endothelial growth factor (anti-VEGF) therapy as ophthalmologists and their patients choose how best to treat DME. Ongoing studies in eyes with DME, nonproliferative diabetic retinopathy, and good visual acuity will help further define the place of modified ETDRS focal/grid laser in the treatment of DME.

The historical discovery of macular edema.

The occurrence of macular edema, or of intraretinal fluid in general, was largely unknown prior to the invention of the ophthalmoscope. One of the first reports on 'Retinitis in Glycosuria', a disease complex, which today would partly be described as diabetic maculopathy, was published in 1856 by Jaeger. His observations were confirmed less than twenty years later by Nettleship in London, and in 1875 Appolinaire Bouchardat from Paris described fluid and lipid accumulation in the macula which led--in his words--to a glucose induced amblyopia. The first pathophysiological hypotheses of fluid accumulation in the posterior pole were then put forward in 1882 by Tartuferi, who thought the edema represented swelling of photoreceptor sheaths. In 1896, the Frenchman Nuel coined the term 'oedème maculaire' which he had observed in a retinitis pigmentosa patient. However, it was not until the end of the first World War, that the Swiss ophthalmologist Alfred Vogt observed macular edema in a variety of other ocular conditions such as iridocyclitiOFF macular edema to a macular hole. A quarter of a century later Bangerter coined the German term 'Zystoides Makulaödem', and in 1950, Hruby was the first to draw attention to the development of macular edema after cataract extraction. Three years later this was followed by Irvine's classical paper on cystoid macular edema after intra- and extracapsular cataract extraction which had been complicated by incarceration of the vitreous in the anterior segment with consecutive tugging on the macula. A decade later, the phenomenon of cystic fluid accumulation in the macula after cataract extraction was further characterised by Gass and Norton using fluorescein angiography. The ensuing years saw the emergence of new concepts regarding the blood-retinal barrier and the paramount role of its dysfunction in the development of macular edema.

[The first description of the Irvine syndrome]. / Die Erstbeschreibung des "Irvine-Syndroms".

Recently G. O. H. Naumann and W. Seibel, while reviewing the literature, stated that A. R. Irvine had not noticed the foregoing biomicroscopic observations of K. Hruby. The name Hruby-Irvine-Gass Syndrome would thus be more appropriate. The article concludes with a discussion of therapeutic problems.