Supplemental oxygen improves diabetic macular edema: a pilot study

Abstract

Diabetic macular edema (DME) is the most common cause of moderate visual disability in working-age persons in the United States. The pathogenesis of DME is poorly understood. Five patients with chronic DME despite at least one focal laser photocoagulation treatment (nine eyes) received 4 L/min of inspired oxygen by nasal cannula for 3 months. Best corrected visual acuity (VA) and retinal thickness, assessed by optical coherence tomography (OCT), were measured at baseline, during 3 months of oxygen treatment, and after stopping oxygen. After 3 months of oxygen therapy, none of nine eyes with DME ate baseline showed a reduction in thickness of the center of the macula. Foveal thickness (FTH) above the normal range was reduced by an average of 42.5% (range, 14%–100%), excess foveolar thickness (CEN) was reduced by an average of 42.1% (range, 13%–100%), and excess macular volume was reduced by an average of 54% (range, 35%–100%). Statistical analyses suggested that these changes were unlikely to be due to chance (P=0.0077). Three eyes showed improvement in VA by at least 2 lines, one by slightly less than 2 lines, and five eyes showed no change. Three months after discontinuation of oxygen, five of the nine eyes showed increased chickening of the macula compare with when oxygen was discontinued. Supplemental inspired oxygen may decrease macular thickness due to DME, suggesting that retinal hypoxia is involved in the development of DME.—Hans E. Grossniklaus