临床明显的黄斑水肿可以被定义为视网膜在距中心凹 500 μm 处或以内增厚，与视网膜增厚有关的硬性脂质渗出物应在距中心凹 500 μm 处或以内，或者存在≥1 个视盘面积的视网膜增厚区域（其任何一个部分距离中心凹在 1 个视盘直径内）。
可能存在不累及中心凹和累及中心凹的 CSMO。
发生累及黄斑中央的 CSMO 的眼睛需要玻璃体内注射抗血管内皮生长因子 (VEGF) 治疗。[58]Mitchell P, Bandello F, Schmidt-Erfurth U, et al. The RESTORE Study: Ranibizumab Monotherapy or Combined with Laser versus Laser Monotherapy for Diabetic Macular Edema. Ophthalmology. 2011 Apr;118(4):615-25.http://www.ncbi.nlm.nih.gov/pubmed/21459215?tool=bestpractice.com[59]Nguyen QD, Brown DM, Marcus DM, et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012 Apr;119(4):789-801.http://www.aaojournal.org/article/S0161-6420%2811%2901242-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/22330964?tool=bestpractice.com[60]Do DV, Nguyen QD, Boyer D, et al; da Vinci Study Group. One-year outcomes of the da Vinci Study of VEGF Trap-Eye in eyes with diabetic macular edema. Ophthalmology. 2012 Aug;119(8):1658-65.http://www.ncbi.nlm.nih.gov/pubmed/22537617?tool=bestpractice.com视敏度：有高质量的证据表明，对于黄斑水肿累及黄斑中央的糖尿病患者，玻璃体内注射雷珠单抗可快速且持续提高患者视敏度。[59]Nguyen QD, Brown DM, Marcus DM, et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012 Apr;119(4):789-801.http://www.aaojournal.org/article/S0161-6420%2811%2901242-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/22330964?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。视敏度：有高质量的证据表明，对于黄斑水肿累及黄斑中央的糖尿病患者，玻璃体内注射阿柏西普 (aflibercept) 可快速且持续提高患者视敏度。[63]Heier JS, Korobelnik JF, Brown DM. et al. Intravitreal aflibercept for diabetic macular edema: 148-week results from the VISTA and VIVID studies. Ophthalmology. 2016 Nov;123(11):2376-85.http://www.ncbi.nlm.nih.gov/pubmed/27651226?tool=bestpractice.com[64]Sivaprasad S, Prevost AT, Vasconcelos JC, et al. Clinical efficacy of intravitreal aflibercept versus panretinal photocoagulation for best corrected visual acuity in patients with proliferative diabetic retinopathy at 52 weeks (CLARITY): a multicentre, single-blinded, randomised, controlled, phase 2b, non-inferiority trial. Lancet. 2017 Jun 3;389(10085):2193-203.https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31193-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/28494920?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。 VEGF 抗体治疗包括单克隆抗体雷珠单抗、贝伐单抗和融合蛋白阿柏西普。
对于未累及黄斑中央的水肿部分，应当考虑黄斑激光治疗。[52]Early Treatment Diabetic Retinopathy Study Research Group. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. ETDRS report number 2. Ophthalmology. 1987 Jul;94(7):761-74.http://www.ncbi.nlm.nih.gov/pubmed/3658348?tool=bestpractice.com[58]Mitchell P, Bandello F, Schmidt-Erfurth U, et al. The RESTORE Study: Ranibizumab Monotherapy or Combined with Laser versus Laser Monotherapy for Diabetic Macular Edema. Ophthalmology. 2011 Apr;118(4):615-25.http://www.ncbi.nlm.nih.gov/pubmed/21459215?tool=bestpractice.com[59]Nguyen QD, Brown DM, Marcus DM, et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012 Apr;119(4):789-801.http://www.aaojournal.org/article/S0161-6420%2811%2901242-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/22330964?tool=bestpractice.com[60]Do DV, Nguyen QD, Boyer D, et al; da Vinci Study Group. One-year outcomes of the da Vinci Study of VEGF Trap-Eye in eyes with diabetic macular edema. Ophthalmology. 2012 Aug;119(8):1658-65.http://www.ncbi.nlm.nih.gov/pubmed/22537617?tool=bestpractice.com[65]Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study report number 1. Arch Ophthalmol. 1985 Dec;103(12):1796-806.http://www.ncbi.nlm.nih.gov/pubmed/2866759?tool=bestpractice.com视敏度：有高质量的证据表明，对于黄斑水肿累及黄斑中央的糖尿病患者，玻璃体内注射雷珠单抗可快速且持续提高患者视敏度。[59]Nguyen QD, Brown DM, Marcus DM, et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012 Apr;119(4):789-801.http://www.aaojournal.org/article/S0161-6420%2811%2901242-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/22330964?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。视敏度：有高质量的证据表明，对于黄斑水肿累及黄斑中央的糖尿病患者，玻璃体内注射阿柏西普 (aflibercept) 可快速且持续提高患者视敏度。[63]Heier JS, Korobelnik JF, Brown DM. et al. Intravitreal aflibercept for diabetic macular edema: 148-week results from the VISTA and VIVID studies. Ophthalmology. 2016 Nov;123(11):2376-85.http://www.ncbi.nlm.nih.gov/pubmed/27651226?tool=bestpractice.com[64]Sivaprasad S, Prevost AT, Vasconcelos JC, et al. Clinical efficacy of intravitreal aflibercept versus panretinal photocoagulation for best corrected visual acuity in patients with proliferative diabetic retinopathy at 52 weeks (CLARITY): a multicentre, single-blinded, randomised, controlled, phase 2b, non-inferiority trial. Lancet. 2017 Jun 3;389(10085):2193-203.https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31193-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/28494920?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。视敏度：有高质量的证据表明，对于患有轻度至中度非增殖性糖尿病性视网膜病变和黄斑水肿的患者，黄斑激光治疗可减少其 2 至 3 年内的视力丧失。[65]Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study report number 1. Arch Ophthalmol. 1985 Dec;103(12):1796-806.http://www.ncbi.nlm.nih.gov/pubmed/2866759?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。 可以考虑全视网膜光凝术。[58]Mitchell P, Bandello F, Schmidt-Erfurth U, et al. The RESTORE Study: Ranibizumab Monotherapy or Combined with Laser versus Laser Monotherapy for Diabetic Macular Edema. Ophthalmology. 2011 Apr;118(4):615-25.http://www.ncbi.nlm.nih.gov/pubmed/21459215?tool=bestpractice.com[59]Nguyen QD, Brown DM, Marcus DM, et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012 Apr;119(4):789-801.http://www.aaojournal.org/article/S0161-6420%2811%2901242-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/22330964?tool=bestpractice.com[60]Do DV, Nguyen QD, Boyer D, et al; da Vinci Study Group. One-year outcomes of the da Vinci Study of VEGF Trap-Eye in eyes with diabetic macular edema. Ophthalmology. 2012 Aug;119(8):1658-65.http://www.ncbi.nlm.nih.gov/pubmed/22537617?tool=bestpractice.com[68]Patz A, Schatz H, Berkow JW, et al. Macular edema: an overlooked complication of diabetic retinopathy. Trans Am Acad Ophthalmol Otolaryngol. 1973 Jan-Feb;77(1):OP34-42.http://www.ncbi.nlm.nih.gov/pubmed/4738180?tool=bestpractice.com视敏度：有高质量的证据表明，对于黄斑水肿累及黄斑中央的糖尿病患者，玻璃体内注射雷珠单抗可快速且持续提高患者视敏度。[59]Nguyen QD, Brown DM, Marcus DM, et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012 Apr;119(4):789-801.http://www.aaojournal.org/article/S0161-6420%2811%2901242-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/22330964?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。视敏度：有高质量的证据表明，对于黄斑水肿累及黄斑中央的糖尿病患者，玻璃体内注射阿柏西普 (aflibercept) 可快速且持续提高患者视敏度。[63]Heier JS, Korobelnik JF, Brown DM. et al. Intravitreal aflibercept for diabetic macular edema: 148-week results from the VISTA and VIVID studies. Ophthalmology. 2016 Nov;123(11):2376-85.http://www.ncbi.nlm.nih.gov/pubmed/27651226?tool=bestpractice.com[64]Sivaprasad S, Prevost AT, Vasconcelos JC, et al. Clinical efficacy of intravitreal aflibercept versus panretinal photocoagulation for best corrected visual acuity in patients with proliferative diabetic retinopathy at 52 weeks (CLARITY): a multicentre, single-blinded, randomised, controlled, phase 2b, non-inferiority trial. Lancet. 2017 Jun 3;389(10085):2193-203.https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31193-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/28494920?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。视敏度：有高质量的证据表明，对于患有中度至重度非增殖性糖尿病视网膜病变和黄斑水肿的患者，全视网膜光凝术可有效降低重度视力丧失的风险。[68]Patz A, Schatz H, Berkow JW, et al. Macular edema: an overlooked complication of diabetic retinopathy. Trans Am Acad Ophthalmol Otolaryngol. 1973 Jan-Feb;77(1):OP34-42.http://www.ncbi.nlm.nih.gov/pubmed/4738180?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。 经全视网膜光凝术治疗的重度 NPDR/低风险 PDR 患者可能出现早期视力丧失，[67]Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Ophthalmology. 1991 May;98(5 Suppl):766-85.http://www.ncbi.nlm.nih.gov/pubmed/2062512?tool=bestpractice.com 同时进行玻璃体内抗 VEGF 治疗可能缓解。接受玻璃体内抗 VEGF 治疗的糖尿病黄斑水肿患者可能不需要全视网膜光凝术，因为抗 VEGF 治疗会抑制新生血管形成。[64]Sivaprasad S, Prevost AT, Vasconcelos JC, et al. Clinical efficacy of intravitreal aflibercept versus panretinal photocoagulation for best corrected visual acuity in patients with proliferative diabetic retinopathy at 52 weeks (CLARITY): a multicentre, single-blinded, randomised, controlled, phase 2b, non-inferiority trial. Lancet. 2017 Jun 3;389(10085):2193-203.https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31193-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/28494920?tool=bestpractice.com[69]Writing Committee for the Diabetic Retinopathy Clinical Research Network. Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy. JAMA. 2015 Nov 24;314(20):2137-46.http://www.ncbi.nlm.nih.gov/pubmed/26565927?tool=bestpractice.com
玻璃体内抗 VEGF 治疗的主要不良反应是眼内炎，它的发病率约 0.05% 至 1%。[66]Cheung CS, Wong AW, Lui A, et al. Incidence of endophthalmitis and use of antibiotic prophylaxis after intravitreal injections. Ophthalmology. 2012 Aug;119(8):1609-14.http://www.ncbi.nlm.nih.gov/pubmed/22480743?tool=bestpractice.com 黄斑激光治疗的不良反应包括近中心视力丧失、可见盲点和偶尔的脉络膜新生血管形成或中央凹损伤。 广泛视网膜光凝术的不良反应包括黄斑水肿、视野受损（在一些情况下，严重到足以导致失去驾驶许可）、目眩以及夜视丧失。
应建议患者咨询他们的医生，以获得合理的血压和血糖控制。
]抗 VEGF 治疗包括单克隆抗体雷珠单抗、贝伐珠单抗和融合蛋白阿柏西普。
[Figure caption and citation for the preceding image starts]: 经治疗的增殖性糖尿病视网膜病变：广泛视网膜激光瘢痕（箭头）由 Moorfields 影像档案中心提供；经许可后使用 [Citation ends].