Diabetic retinopathy
ICD-10 H36.0 · ICD-11 9B71.0

Treatment of Diabetic Retinopathy in Non-Center-Involved Diabetic Macular Edema (NCI-DME)

Clinical Scenario

This protocol addresses diabetic retinopathy presenting with non-center-involved diabetic macular edema (NCI-DME) — a subtype in which macular thickening or hard exudates do not involve the central foveal zone. Accurate classification of diabetic macular edema as either center-involved (CI-DME) or non-center-involved (NCI-DME) is essential, as the distinction directly determines the appropriate management strategy.

Why This Classification Matters

Diabetic macular edema should be classified as either center-involved (CI-DME) or non-center-involved DME (NCI-DME). The treatment approach for NCI-DME differs from center-involved disease, and the evidence base supporting specific interventions in this subtype is distinct.

Treatment Approach (Summary)

For non-center-involved diabetic macular edema, a focal/grid laser photocoagulation procedure is the recommended intervention. The full protocol specifies the precise technique, targeting parameters, and anatomical boundaries that define current evidence-based practice.

Complete regimen details — including technique specifications and procedural guidance — are in the structured protocol.
Goal: Partial to complete resolution of diabetic macular edema
Instant Access to Structured Evidence-Based Regimens

References

  1. Diabetic macular edema should be classified as either center-involved (CI-DME) or non-center-involved DME (NCI-DME).
  2. The role of anti-VEGF in NCI-DME has not been studied, and the focal/grid laser surgery treatment option is recommended in this scenario.
  3. A modified ETDRS laser surgery treatment is currently recommended; it includes a less intense laser energy, has greater spacing than for a grid, directly targets microaneurysms, and avoids foveal vasculature within at least 500 µm of the center of the macula.
  4. A Cochrane systematic review concluded that laser photocoagulation surgery reduces the chances of visual loss and increases those of partial to complete resolution of DME compared with no intervention at 1 to 3 years.
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