Optical Coherence Tomography for Classification and Clinical Evaluation of Macular Edema in Patients with Uveitis

Purpose: To study use of optical coherence tomography (OCT) for macular edema in uveitis. Methods: In total, 44 patients with uveitis and macular edema underwent OCT. Data obtained were correlated with anatomic type, duration of uveitis, and visual acuity (VA). Results: Both cystoid macular edema (CME) and diffuse macular edema (DME) correlate negatively with VA, although statistically CME showed stronger correlation (p = .02). Also CME had higher mean foveal thickness than DME (p < .01). Negative correlation between foveal thickness and VA (p < .05) was observed. CME correlates with uveitis duration (p < .01). Conclusions: CME and macular thickening correlate with VA reduction and uveitis duration.     

Optical coherence tomographic patterns of diabetic macular edema

PURPOSE: To describe various morphologic patterns of diabetic macular edema (DME) demonstrated by optical coherence tomography (OCT) and correlate them with visual acuity. DESIGN: Retrospective, observational, case series. METHODS: A retrospective review of all patients with DME who underwent OCT evaluation and met the study inclusion criteria between May 1998 and December 2002 at the Cole Eye Institute was performed. The OCT scans were evaluated for the presence of diffuse retinal thickening (DRT), cystoid macular edema (CME), posterior hyaloidal traction (PHT), serous retinal detachment (SRD), and traction retinal detachment (TRD). Additionally, the retinal thickness was measured and visual acuity evaluated. RESULTS: Two hundred seventy-six OCT scans of 164 eyes of 119 patients were identified. OCT revealed five morphologic patterns of DME: DRT (269, 97%), CME (152, 55%), SRD without PHT (19, 7.0%), PHT without TRD (35, 12.7%), and PHT with TRD (8, 2.9%). Mean retinal thickness varied depending on the morphologic pattern. The mean visual acuities (Snellen equivalent) also varied between groups. Increasing retinal thickness in all patterns was significantly correlated with worse visual acuity (P < .005). The OCT patterns containing CME (P = .01) and PHT without TRD (P = .02) were also significantly associated with worse vision. CONCLUSIONS: DME exhibits at least five different morphologic patterns on OCT. There is a significant correlation between retinal thickness and visual acuity.     

糖尿病视网膜病变患者黄斑病变的 光学相干断层扫描

目的观察糖尿病视网膜病变患者黄斑病变的光学相干断层扫描(optical coherence tomography,OCT)图像特征。方法对60例糖尿病黄斑病变患者以及30例正常对照者进行OCT检查。其中54例糖尿病黄斑病变患者同时行荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查,对两种检查方法的结果进行比较。结果OCT检查糖尿病黄 斑病变患者中心凹平均厚度为(314.54±154.13)μm。视网膜水肿者占57.1%,视网膜水肿合并黄斑囊样水肿(cystoid macular edema,CME）者占38.5%,合并神经上皮脱离者 占9.2%,合并CME及神经上皮脱离者占16.9%。OCT检查黄斑正常厚度及轻度水肿者,FFA主要呈限局性渗漏;中重度水肿者,FFA呈弥漫性渗漏。CME检出率FFA检查者为28.6%,OCT检 查者为58.9%,二者比较差异有显著性意义(t=3.39,P<0.05) 。结论糖尿病黄斑病变者的OCT图像有视网膜水肿、CME及神经上皮脱离3种形态特征。OCT在检测发现CME等方面优于FFA。(中华眼底病杂志,2001,17:184-186)     

Comparison between optical coherence tomography and fundus fluorescein angiography for the detection of cystoid macular edema in patients with uveitis

PURPOSE: To compare optical coherence tomography (OCT) with fundus fluorescein angiography (FFA) for the detection of cystoid macular edema (CME) in patients with uveitis. DESIGN: Prospective comparative observational series. PARTICIPANTS: One hundred twenty-one eyes of 58 patients with uveitis of varied causes (seven patients were studied twice). TESTING: Patients with suspected CME underwent OCT scanning followed by FFA at the same visit. MAIN OUTCOME MEASURES: Detection and distribution of macular edema. RESULTS: One hundred eight eyes had similar results on both OCT and FFA in that 67 eyes had CME and 41 eyes had no CME. In 10 eyes subretinal fluid was detected on OCT but not FFA. Five of these eyes had CME on FFA but not OCT. Three other eyes had CME that was detected by FFA but not by OCT. Compared with FFA, the OCT sensitivity for detecting CME was 96% (including the eyes with subretinal fluid), and the OCT specificity was 100%. CONCLUSIONS: OCT is as effective at detecting CME as is FFA but is superior in demonstrating axial distribution of fluid.     

Prevalence of cystoid macular edema and stability in oct retinal thickness in eyes with retinitis pigmentosa during a 48-week lutein trial

PURPOSE: To describe, in a group of patients with moderately advanced retinitis pigmentosa (RP), the prevalence of cystoid macular edema (CME), the variation in foveal thickness over a 48-week period, the correlation of visual acuity (VA) with retinal thickness, and the lack of response of CME to lutein administration. METHODS: Optical coherence tomography (OCT) imaging of the macula and clinical examination were evaluated for 77 eyes of 39 patients with RP over 11 months, with a scan done every 6 weeks. RESULTS: The prevalence of CME, defined by cysts visible on OCT, was 49%. Bilateral CME was present in 44% of patients (17 of 39), and an additional two patients had unilateral CME. Central retinal thickness varied little over the 48 weeks. Sixty-six percent of the eyes with CME had VA of 20/40 or better. The eyes with CME with VA worse than 20/40 had either greater degrees of thickening or in fact had lower thickness measures. For the eyes without CME, the eyes with VA worse than 20/40 tended to have lower retinal thickness than the eyes with VA of 20/40 or better. VA was highly concordant between eyes, and did not differ significantly between the groups with and without CME. Lutein did not show a statistically significant effect on retinal thickness in the patients with or without CME, nor was such an effect observed in subgroups of patients with vision better or worse than 20/40. CONCLUSION: The prevalence rate of CME is higher than in previous reports, perhaps because the patients had some preserved macular vision and because of the use of a definition based on OCT findings. Retinal thickness remains fairly stable over time, both in eyes with CME and in eyes without CME.     

视网膜静脉阻塞致黄斑水肿患者相干光断层扫描和视力预后观察

目的探讨相干光断层扫描(optical coherence tomography,OCT)检测视网膜静脉阻塞致黄斑水肿患者的灵敏度(sensitivity,Sen)、特异度(specificity,Spe)及其视力预后影响因素.方法应用OCT和荧光素眼底血管造影(FFA)检测90例(91只眼)各型视网膜静脉阻塞患者.其中男性54例,女性36例;年龄20～74岁,平均(57.8±13.8)岁;45只右眼,46只左眼(其中1例为双眼);视网膜中央静脉阻塞54只眼,半侧静脉阻塞9只眼,分支静脉阻塞28只眼.追踪观察时间1～46个月,平均6.1个月.比较OCT和FFA的灵敏度和特异性.并检测55例另侧健眼的黄斑中心区视网膜厚度,以进行比较分析.结果 (1)在OCT扫描下观察黄斑水肿的形态,有黄斑囊样水肿71只眼(78.0%),视网膜神经上皮下积液14只眼(15.4%),黄斑板层裂孔1只眼(1.1%).黄斑囊样水肿的囊泡高度最小为94 μm,最大为1317 μm,平均(668.18±245.58)μm.54只对侧健眼黄斑中心区视网膜厚度最小为110 μm,最大为236 μm,平均(154.09 ± 21.85)μm.视网膜神经上皮下积液,最高可达1377 μm,甚至超过OCT所能检测的高度.(2)OCT检测黄斑囊样水肿的灵敏度为98.6%、特异度为100%;FFA的灵敏度为86.1% 、特异度为100.0%.(3)黄斑囊样水肿患者的视力预后随访3个月以上的黄斑囊样水肿患者60例(61只眼),分支静脉阻塞致黄斑水肿患者治疗前后视力差异有统计学意义(P<0.01),中央静脉阻塞和半侧静脉阻塞患者治疗前后视力差异无统计学意义(P>0.05).影响患者视力预后的因素有病程长短、黄斑中心区是否积血、病情严重程度等.病程<3个月的患者治疗前后视力差异有统计学意义(P<0.01),而病程≥3个月的患者治疗前后视力差异无统计学意义(P>0.05).结论应用OCT检测视网膜静脉阻塞致黄斑水肿患者,其方法安全,诊断结果可靠,解析度高,是非侵入性、可重复操作的新技术.但黄斑囊样水肿患者视力预后差,应大力推广OCT检查技术,以便早期发现、早期治疗,以改善患者视力.     

Evaluation of systemic risk factors in different optical coherence tomographic patterns of diabetic macular edema

AIM: To elucidate the relationship between systemic risk factors and different patterns of diabetic macular edema (DME) determined with optical coherence tomography (OCT). METHODS: In this cross-sectional study, DME was classified by OCT as diffuse retinal thickness (DRT), cystoid macular edema (CME) and serous retinal detachment (SRD) and the relationship between the systemic risk factors and DME patterns was evaluated. RESULTS: Of the 57 patients with DME, 21 (36.8%) had DRT, 24 (42.1%) had CME and 12 (21.0%) had SRD. Micro- or macro-albuminuria was significantly higher in the DRT pattern (61.9%) compared with the SRD (50.0%) and CME patterns (25.0%; P=0.040). Hemoglobin A1c (HbA1c) level was significantly higher and patients were younger in the DRT pattern group (P=0.034, P=0.032). Best corrected visual acuity was the worst and central macular thickness was the thickest in the CME pattern group. CONCLUSION: Micro- or macro-albuminuria may be more frequent and HbA1c level may be higher in patients with DRT. These patients are also seen to be younger than patients with non-DRT.     

上海北新泾社区2型糖尿病患者黄斑水肿患病情况调查

目的 了解社区糖尿病视网膜病变患者黄斑水肿的患病情况。方法对上海北新泾街道社区100例（151只眼）15岁以上2型糖尿病患者进行直接检眼镜、眼底照相、超声波及相干光断层扫描（OCT）检查,并对检查结果进行统计学分析。结果实际调查对象795人,发现有糖尿病视网膜病变者215例,随机抽取100例糖尿病患者,有151只眼发生糖尿病视网膜病变,其黄斑中心凹平均厚度195．7μm;有46只眼的黄斑增厚,其中黄斑视网膜海绵样肿胀35只眼（76．1％）,黄斑囊样水肿8只眼（17．4％）,神经上皮层脱离3只眼（6．5％）。黄斑中心凹厚度与最佳矫正视力的负对数之间有相关性（r=0．2869,P=0．0004）。不同程度糖尿病视网膜病变者其黄斑水肿的患病情况有所不同（P=0．0003）。糖尿病黄斑水肿的发生与玻璃体后脱离情况的关联无统计学意义（P=0．472）。结论社区糖尿病视网膜病变患者中黄斑水肿患病率为37．1％。患眼的OCT图像归为三种类型：视网膜海绵样肿胀、黄斑囊样水肿及神经上皮层脱离。糖尿病视网膜病变的程度越重,发生黄斑水肿的可能性越大。糖尿病黄斑水肿与有无玻璃体后脱离无明显联系,与总胆固醇水平呈负相关。（中华腰科杂志．2007,43：626-630）     

Optical coherence tomography features during the evolution of serous retinal detachment in patients with diabetic macular edema

PURPOSE: To characterize the evolution of serous retinal detachment (SRD) combined with diabetic macular edema (DME) using optical coherence tomography (OCT). DESIGN: Observational retrospective case series. METHODS: In our institution, 64 eyes of 40 diabetic patients who had SRD combined with DME were studied. All patients had fluorescein angiography and several OCT3 examinations during follow-up. Foveolar neuroretinal thickness (NRT) and SRD height were measured. The evolution of OCT macular profiles was qualitatively assessed. RESULTS: Mean follow-up was 11.8 months. DME was focal in 10 eyes (15.6%), diffuse in 17 (26.6%) and both diffuse and focal in 37 (57.8%). Mean initial decimal visual acuity (VA), NRT, and SRD height (+/- standard deviation) were 0.35 +/- 0.21, 346.88 +/- 138.61 and 199.48 +/- 139.8 microm, respectively. SRD height did not correlate with VA (P = .23) or NRT (P = .31). In 13 eyes (20.3%), NRT above the SRD was normal. In the 19 eyes where DME improved during follow-up, SRD disappeared before the maximal reduction of retinal thickness in seven eyes (36.8%) and after or simultaneously with this reduction, in 12 eyes (63.2%). Among the 45 eyes where DME worsened during follow-up, SRD disappeared from 15 eyes (33.3%). CONCLUSION: In this series, SRD height did not correlate with retinal thickening. The latter may appear before central neuroretinal thickening and disappear before or after its regression. Consequently, SRD does not seem to be related either to the severity of DME or to its resorption.     

不同OCT分型的糖尿病性黄斑水肿与血小板参数的关系

目的研究不同OCT分型的糖尿病性黄斑水肿(diabetic macular edema,DME)与血小板参数的关系。方法回顾性研究。118例(118眼)糖尿病视网膜病变(diabetic retinopathy,DR)患者中,DME组88眼,未合并DME(Non-DME)组30眼,根据DME的OCT形态分为弥漫性视网膜增厚型(diffuse retinal thickening,DRT)27眼、黄斑囊样水肿(cystoid macular edema,CME)29眼、神经上皮层脱离型(neurosensory retinal detachment,NSD)32眼,对不同组别间患者血小板计数(platelet count,PLT)、平均血小板体积(mean platelet volume,MPV)、血小板平均分布宽度(platelet distribution width,PDW)和血小板压积(plateletcrit,PCT)进行比较,并分析DR分期与DME的OCT分型间的关系。结果DRT在轻度和中度非增生型DR中的占比为50.0%,而NSD在重度非增生型DR及增生型DR患眼中的占比较高,为84.5%。DME组患者的MPV和PDW均明显高于Non-DME组(均为P<0.05),NSD患者的MPV和PDW均明显高于DRT和CME患者(均为P<0.05)。结论不同DME分型的患者MPV、PDW有差异,血小板与NSD的发生、发展可能相关。     

Optic Coherence Tomography of Idiopathic Macular Epiretinal Membranes

OBjectives:To study the characteristics of optical coherence tomography(OCT) in idiopathic macular epiretinal membranes(IMEM)and the relationship between the thickness of fovea and the vision of affected eyes.Methods:A total of 67 cases(73 eyes)with clinical diagnisis of IMEM using direct indirect ophthalmoscope,three mirror contact lens,fundus color photography or nfundus fluorescein angiography(FFA) were examined with OCT.Results:Epiretinal membranes(ERMs)with macular edema were found in 32 eyes, proliferative ERMs in 20 eyes,ERMs withmacular pseudoholes in 14 eyes and ERMs with laminar macular holes in 7eyes.Based on OCT,the ERMs were clearly and partially seperated from the retinal (27 eyes,38.36%),the retinal thickness of the fovea was the thickest in the proliferative ERMs and the thinnest in the ERMs with laminar macular holes.The statistical analysis showed there was a negative correlation between the thickness of fovea and visual acuity (r=-0.454,P=0.000).Conclusion:There were four types of images of OCT in IMEM:ERMs with macular edema,proliferative ERMs,ERMs with macular pseudohole and ERMs with laminar macular hole;and the thicker the fovea under the OCT,the poorer the vision acuity in the affected eyes with ERMs.     

Assessment of serous macular detachment in eyes with diabetic macular edema by use of spectral-domain optical coherence tomography

Background

The introduction of optical coherence tomography (OCT) has brought new potentialities for an objective evaluation of macular diseases. The purpose of the present study was to assess the serous macular detachment (SMD) in eyes with diabetic macular edema (DME) by use of spectral-domain OCT.

Methods

In this prospective study were included 79 eyes of 46 patients with diabetic retinopathy and DME. All patients underwent examination of best-corrected visual acuity (BCVA), non-contact slit-lamp fundus biomicroscopy, fluorescein angiography and OCT. Spectral-domain OCT (OCT/SLO Combination Imaging System, OPKO/OT Inc., Toronto, Ontario, Canada) was used to evaluate retinal morphology and the presence of macular traction (vitreomacular and/or from epiretinal membranes) on B-scans, C-scans and C-scan OCT/SLO fundus image overlays. With OCT were measured retinal thickness, volume, diameter of intraretinal cystoid spaces, diameter and height of SMD. The correlation of retinal thickness and volume with BCVA in all eyes with DME and the relation of SMD to retinal thickness, volume, BCVA, macular traction and ischemia were assessed.

Results

The SMD was diagnosed only by means of OCT in nine eyes (11.4%) of five patients. In eight of nine eyes it was combined with intermediate (300–600 µm) or severe (>600 µm) cystoid spaces, and in one eye with simple macular edema. Retinal thickness and volume correlated with BCVA (r?=?0.464, P?<?0.0001 and r?=?0.480, P?<?0.0001). The SMD height did not correlate with retinal thickness, volume or BCVA. Six eyes with SMD had macular ischemia, and five eyes had severe ischemia in retinal periphery. Macular traction was: absent in three eyes, questionable (without distortion of retinal contour from partial posterior vitreous detachment and/or epiretinal membrane) in three eyes, and definite (with distortion of retinal contour) in three eyes.

Conclusions

Spectral-domain OCT provided valuable information on retinal morphology and was particularly useful in diagnosing sub-clinical SMD in eyes with DME. It disclosed the presence and strength of macular traction either by partially detached posterior hyaloid or by epiretinal membranes. C-scans and C-scan OCT/SLO fundus image overlays added complementary information for the extent and location of the pathological features. Larger studies which follow subjects longitudinally are needed to explain the pathogenesis and determine the prognosis of SMD.     

Clinical and optical coherence tomographic findings and outcome of treatment in patients with presumed tuberculous uveitis

Purpose To define the clinical characteristics and optical coherence tomographic (OCT) features, and to assess the outcome of treatment, in patients with presumed tuberculous uveitis (PTU). Methods All patients diagnosed with PTU at King Abdulaziz University Hospital between January 1998 and May 2006 were reviewed. The diagnosis was made when findings were consistent with possible intraocular tuberculosis with no other cause of uveitis suggested by history, symptoms, or ancillary testing, strongly positive tuberculin skin-test results, and response to antituberculous therapy. Results Fifty-one patients (73 eyes) were identified. There were 34 males (66.7%) and 17 females (33.3%) with a mean age of 40.1 ± 11.0 years (range 16–68 years). Fifty-eight eyes (79.5%) had panuveitis and 15 eyes (20.5%) had posterior uveitis at presentation. Clinical manifestations included vitritis (71.2%), macular edema (63%), retinal periphlebitis (35.6%), multifocal choroiditis (20.5%), and granulomatous anterior uveitis (17.9%). All patients received antituberculous therapy and systemic corticosteroids. After a mean follow-up of 18.9 ± 21.9 months (range 6–96 months), all eyes showed resolution of inflammation, with no recurrences, associated with significant improvement in visual acuity (VA) (P = 0.007). There was a significant positive correlation between initial and final VAs (r = 0.7856, P < 0.001). Thirty-one eyes with macular edema were examined at baseline and at follow-up with OCT. There were three patterns of macular edema: diffuse (DME) (28.5%), cystoid (29%), and serous retinal detachment (45.2%). Initial VA of 20/40 or better was significantly associated with central macular thickness (CMT) of 300 μm or less (P = 0.0065) and DME (0.0484). At final follow-up, there was a significant reduction in CMT (P < 0.001) associated with a significant improvement in VA (P = 0.0091). Conclusions Antituberculous therapy combined with systemic corticosteroids leads to resolution of inflammation and elimination of recurrences of PTU. OCT is useful in monitoring the efficacy of treatment in patients with macular edema.     

Reading performance of patients with uveitis-associated cystoid macular edema

PURPOSE: To evaluate the extent of the visual impairment caused by uveitis-associated cystoid macular edema (CME) and compare the results with lesion size. DESIGN: Observational case series. METHODS: setting: Uveitis outpatient clinic of the Department of Ophthalmology and Optometry, Medical University of Vienna. patient population: CME was verified in 30 eyes of 30 consecutive uveitis patients with optical coherence tomography and lesion size was assessed with retinal thickness analyzer. main outcome measures: Distance visual acuity (VA) (measured with Early Treatment Diabetic Retinopathy Study charts), reading acuity, and reading speed (tested with Radner Reading Charts). Results were compared with nonaffected partner eyes. RESULTS: Distance VA was logMAR 0.22 +/- 0.15 in CME eyes vs -0.02 +/- 0.17 in healthy controls. Reading acuity was 75% of logMAR in CME eyes vs 92% of logMAR in control eyes (P = .01). The mean reading speed was 148.4 +/- 36.6 words per minute in patients with CME vs 168.9 +/- 36.3 in patients without CME (P = .04). Reading acuity correlated with both lesion size and distance VA (r = 0.61; P = .01 and r = 0.53; P = .028, respectively). Neither anatomical classification of uveitis nor gender or age had a significant influence on the evaluated parameters. CONCLUSIONS: Reading acuity and reading speed were considerably more impaired than distance visual acuity. The assessed parameters showed a better correlation to lesion size and seem to be a better reflection of macular dysfunction. Analyzing reading function is an important factor when following patients with CME and evaluating success of treatment modalities.     

Anatomy and function of the macula after surgery for retinal detachment complicated by proliferative vitreoretinopathy

PURPOSE: To investigate the macular changes following silicone oil removal after surgery for complicated retinal detachment (RD) with proliferative vitreoretinopathy (PVR). DESIGN: Retrospective interventional case series. METHODS: setting: Vienna, Austria. study population: Thirty-nine patients with attached retina after silicone oil removal following previous vitrectomy and silicone oil tamponade for complicated RD and PVR grade C3 and worse. observation procedures: Examination of macular anatomy with biomicroscopy, optical coherence tomography (OCT), and fluorescein angiography (FA). Macular function was tested by assessing logMAR distance visual acuity (VA) using Early Treatment Diabetic Retinopathy Study (ETDRS) charts and reading acuity and reading speed using a standardized test (Radner charts). main outcome measures: Macular anatomy, VA, reading acuity, and reading speed. RESULTS: The macula was clinically normal in five patients (12.8%). Retinal pigment epithelium (RPE) irregularities were found in nine patients (23.1%). Eight patients (20.5%) had macular pucker, seven (18.0%) had cystoid macular edema (CME), and 10 (25.6%) had subretinal fibrosis. The mean VA of all patients was logMAR 0.67 +/- 0.68 (range, -0.1 to 3.0). Six eyes did not achieve reading acuity. The distance VA of the remaining 33 eyes was logMAR 0.44 +/- 0.29 and their mean reading acuity was logRAD 0.62 +/- 0.35, with a reading speed ranging from 55 to 240 words per minute. CONCLUSIONS: We found macular changes in 87% of the patients, one-third thereof being eligible for further treatment (macular pucker or CME). Thus, the majority of these patients do not seem to be eligible for a further improvement of anatomic or functional outcome.     

Safety and efficacy of intravitreal triamcinolone acetonide for uveitic macular edema

BACKGROUND: To evaluate the safety and efficacy of intravitreal triamcinolone acetonide (TA) for treating macular edema secondary to non-infectious uveitis. METHODS: Retrospective review of sixteen patients (20 eyes) with chronic cystoid macular edema (CME) as a consequence of controlled intermediate uveitis, posterior uveitis, or panuveitis who received at least one intravitreal injection of TA. Main outcome measures were visual acuity (VA), intraocular pressure (IOP), formation or progression of an existing cataract, and CME resolution during the follow-up period. RESULTS: At last follow-up, VA showed improvement (compared to baseline) in 11 eyes (55%), deterioration in three eyes (15%), remained completely unchanged in one eye (5%), and showed improvement initially but returned to baseline levels in five eyes (25%). At last follow-up, CME had relapsed or was still present in 10 of the eyes (50%). The remaining eyes showed complete resolution of the CME, without evidence of recurrence during the follow-up time. Mean VA at last follow-up showed statistically significant improvement (p = 0.02) in nonvitrectomized eyes (mean baseline VA: 1.14 +/- 0.58; mean final VA: 0.96 +/- 0.66) compared to the almost unaltered mean visual acuity for vitrectomized eyes (mean baseline VA: 0.76 +/- 0.41; mean final VA: 0.71 +/- 0.48)(p = 0.40, paired samples t-test). Elevation of IOP was transient in all cases and responded well to topical medications, except for one patient who required placement of an Ahmed valve. Preexisting cataract progressed in three of the 15 phakic eyes (20%). One patient developed a retinal detachment and required additional surgery to reattach it. Patients were followed for a mean of 34 weeks (median: 32 weeks; range: 19-56 weeks). CONCLUSIONS: Intravitreal TA may play a role in the treatment of uveitis-related CME. Further controlled studies are necessary to test this hypothesis.     

Comparison of time-domain OCT and fundus photographic assessments of retinal thickening in eyes with diabetic macular edema

PURPOSE: To explore the correlation between optical coherence tomography (OCT) and stereoscopic fundus photographs (FP) for the assessment of retinal thickening (RT) in diabetic macular edema (DME) within a clinical trial. METHODS: OCT, FP, and best corrected visual acuity (VA) measurements were obtained in both eyes of 263 participants in a trial comparing two photocoagulation techniques for DME. Correlation coefficients (r) were calculated comparing RT measured by OCT, RT estimated from FP, and VA. Principal variables were central subfield retinal thickness (CSRT) obtained from the OCT fast macular map and DME severity assessed by a reading center using a seven-step photographic scale combining the area of thickened retina within 1 disc diameter of the foveal center and thickening at the center. RESULTS: Medians (quartiles) for retinal thickness within the center subfield by OCT at baseline increased from 236 (214, 264) microm in the lowest level of the photographic scale to 517 (455, 598) microm in the highest level (r = 0.67). However, CSRT interquartile ranges were broad and overlapping between FP scale levels, and there were many outliers. Correlations between either modality and VA were weaker (r = 0.57 for CSRT, and r = 0.47 for the FP scale). OCT appeared to be more reproducible and more sensitive to change in RT between baseline and 1 year than was FP. CONCLUSIONS: There was a moderate correlation between OCT and FP assessments of RT in patients with DME and slightly less correlation of either measure with VA. OCT and FP provide complementary information but neither is a reliable surrogate for VA.     

Cystoid macular edema associated with topical latanoprost in glaucomatous eyes with a normally functioning blood-ocular barrier.

PURPOSE: To study prospectively using optical coherence tomography (OCT) whether topical latanoprost induces retinal disorders, such as cystoid macular edema, in patients with glaucoma and a normally functioning blood-ocular barrier. METHODS: Sixty-eight eyes of 38 patients with glaucoma and no history of intraocular surgery, uveitis, or laser trabeculoplasty were studied. Before initiation of latanoprost treatment and after 1, 3, and 6 months of treatment, OCT images were taken, and the following tests were performed: visual acuity examination, fundus ophthalmoscopy, intraocular pressure measurement, and fundus color photography. To evaluate retinal thickness in the fovea accurately. OCT scanning was repeated six times, and the smallest value was used as the retinal thickness in the fovea. RESULTS: Latanoprost ophthalmic solution did not influence retinal thickness in the fovea at any investigated time points compared with the time before instillation, and no changes were observed in visual acuity, ophthalmoscopic findings, and fundus photographs. The intraocular pressure was reduced significantly at all investigated time points compared with the time before instillation. CONCLUSIONS: It is unlikely that topical latanoprost induces retinal disorders, such as cystoid macular edema, in glaucomatous eyes with a normally functioning blood-ocular barrier.     

Course of macular edema in uveitis under medical treatment

OBJECTIVE: To describe the response of uveitic macular edema to various treatment methods using optical coherence tomography (OCT). METHODS: This is a prospective study of consecutive uveitis patients with macular edema in at least one eye. The patients received medical treatment. Best corrected Snellen Visual Acuity (BCVA) and tomographic features of the macula, including macular thickness measurement, were obtained at one, three, six, and 12 months after commencing treatment. RESULTS: Eighty-one eyes of 58 patients were analyzed. Complete resolution of macular edema occurred in 38 eyes (47%). The average BCVA was 20/34 logarithm of minimum angle of resolution (-logMAR, 0.2 +/- 0.3) upon study entry and 20/27 (-logMAR, 0.13 +/- 0.29) upon study completion. The difference was statistically significant (p = 0.04). The corresponding mean retinal thickness at the central fovea was 319 +/- 150 microm at the beginning of the study compared to 241 +/- 125 microm at 12 months (p < 0.001). A weak but statistically significant correlation between the reduction of macular thickness and the improvement of BCVA (r = 0.3, p = 0.01) was found. Thirteen of the 43 eyes (30%) with persistent macular edema had a more than 15% reduction of macular thickness compared to baseline, whereas 10 eyes (23, 3%) had a more than 15% increase in macular thickness. Statistical analysis indicated that the presence of an epiretinal membrane and an OCT pattern of diffuse macular edema was a significant factor associated with medical treatment failure. CONCLUSION: This study demonstrates the overall favorable visual prognosis of uveitic macular edema under medical treatment. The presence of an epiretinal membrane is an important factor associated with medical treatment failure.     

曲安奈德辅助玻璃体切割及常规玻璃体切割治疗弥漫性糖尿病黄斑水肿临床疗效观察

目的 对比研究曲安奈德辅助玻璃体切割与单纯玻璃体切割手术治疗弥漫性糖尿病黄斑水肿的临床效果.方法 回顾性收集2004年6月至2007年9月因弥漫性糖尿病黄斑水肿性行玻璃体切割治疗的29只眼28例病人,分为:单纯玻璃体切割及TA辅助玻璃体切割两组.所有患者均严格控制血糖、血压,术前均详细检查视力、眼压、裂隙灯、检眼镜眼底、荧光血管造影(FFA)、光学相干断层扫描(OCT),分别记录术前术后1月、3月、6月、12月视力及黄斑厚度,进行对比,并观察手术后并发症,全部患者术后平均随访(13.8±1.2)月,结果所有患者均顺利进行玻璃体手术治疗,单纯玻璃体切割组:术前患者平均视力0.15±0.09,术后1月、3月、6月、12月平均视力0.13±0.08、0.16±0.11、0.22±0.09、0.26±0.12,术前黄斑厚度平均OCT值(434±121)μm,术后1月、3月、6月、12月平均OCT值为(358±108)μm、(322±86)μm、(284±69)μm、(246±75)μm,TA辅助玻璃体切割组:术前患者平均视力0.13±0.07,术后1月、3月、6月、12月平均视力0.12±0.06、0.15±0.09、0.21±0.11、0.24±0.10,术前黄斑厚度平均OCT值(452±106)μm,术后1月、3月、6月、12月平均OCT值为(295±113)μm、(276±77)μm、(261±52)μm、(233±58)μm,两组患者术后12月视力均较术前明显提高,有统计学差异,黄斑中心凹厚度变化,各观察时间点均较术前有统计学意义下降.对比两组患者术前术后各观察时间点视力及黄斑中心凹厚度变化显示,TA辅助玻璃体切割组术后早期黄斑中心凹厚度下降程度,较单纯玻璃体切割组明显,有统计学意义.术中TA辅助玻璃体切割组3例出现医源性网膜裂孔,激光封口,无患者术后出现玻璃体出血,虹膜新生血管,视网膜前膜,无患者行白内障手术.结论 两种方法显示,玻璃体切割手术可显著减轻弥漫性糖尿病黄斑水肿并逐步改善患者视功能,TA辅助玻璃体切割手术增加了术中透明玻璃体可视性,有利于后极部玻璃体切除,术后可较快恢复黄斑组织结构,对于手术治疗减轻黄斑水肿机制及手术远期效果还需大样本多中心临床观察.