Optical coherence tomography for evaluating diabetic macular edema before and after vitrectomy

PURPOSE: To report the use of optical coherence tomography (OCT) for evaluation of diffuse diabetic macular edema (DME) before and after vitrectomy. DESIGN: Interventional case series. METHODS: A retrospective study was made of 15 consecutive eyes of 13 patients that had vitrectomy for diffuse DME and OCT preoperatively and postoperatively. In seven eyes of six patients (group 1), vitrectomy was performed because of vitreomacular traction observed on biomicroscopy or OCT. In the other eight eyes of seven patients (group 2), vitrectomy was performed for DME not responsive to laser photocoagulation, with no vitreomacular traction on biomicroscopy or OCT. RESULTS: Mean +/- standard deviation (SD) follow-up after vitrectomy was 18 +/- 10 months (range, 6 to 33 months). In group 1, mean +/- SD retinal thickness decreased significantly from 661 +/- 181 microm preoperatively to 210 +/- 32 microm at the end of follow-up (P =.018). Median best-corrected visual acuity (BCVA) improved from 20/100 before surgery (range, 20/250 to 20/50) to 20/80 at the end of follow-up (range, 20/250 to 20/25; P =.046). In one eye in group 1, vitreomacular traction was only observed on OCT and not on biomicroscopy. In group 2, mean +/- SD retinal thickness decreased from 522 +/- 103 microm preoperatively to 428 +/- 121 microm at the end of follow-up (P =.2). Median BCVA was 20/100 before vitrectomy (range, 20/320 to 20/63) and 20/200 at the end of follow-up (range, 20/250 to 20/63; P =.78). CONCLUSIONS: Vitrectomy was beneficial in eyes with diffuse DME combined with vitreomacular traction but not in eyes without traction. Optical coherence tomography allowed diagnosis of subtle vitreomacular traction and provided precise preoperative and postoperative assessments of macular thickness.     

糖尿病性黄斑水肿的光学相干断层成像

目的:观察糠尿病性黄斑水肿(diabetic macular edema,DME)的光学相干断层成像(optical coherence tomography,OCT)图像特征,分析其黄斑视网膜厚度与视力的关系.方法:对50例80眼经检眼镜或荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查确诊为糖尿病视网膜病变伴黄斑水肿的患者进行经黄斑中心凹水平和垂直线性扫描的OCT检查.结果:10眼表现为黄斑中心凹局限性水肿改变,21眼表现为黄斑中心凹囊样改变伴神经上皮层浆液性脱离,49眼表现为黄斑区视网膜神经上皮层弥漫性增厚.DME患者黄斑视网膜厚度与视力呈负相关关系(r=-0.60,P=0.000).结论:DME的主要OCT图像特征为黄斑视网膜弥漫性水肿、黄斑囊样水肿伴神经上皮层脱离和黄斑局限性水肿改变;DME患者黄斑水肿越严重,视力越差.     

Optical coherence tomography findings in persistent diabetic macular edema: the vitreomacular interface

PURPOSE: To assess the optical coherence tomography (OCT) characteristics of eyes with persistent clinically significant diabetic macular edema (PDME) after focal laser treatment, with emphasis on the vitreomacular interface (VMI) characteristics. DESIGN: Prospective, observational case series. METHODS: Fifty eyes with PDME after at least one focal laser treatment were enrolled prospectively. Slit-lamp biomicroscopy, stereoscopic fundus photography, fluorescein angiography (FA), and OCT were performed for each eye. The main outcome measures included the detection rate of VMI abnormalities (VMIA) by OCT in comparison with biomicroscopy, fundus photography, and FA (traditional techniques); the relationship between VMIA and the number of focal laser sessions per eye and FA leakage pattern. RESULTS: Two of 50 eyes were excluded because of incomplete data. For the remaining 48 eyes, 25 eyes (52.1%) demonstrated definite VMIA, including anomalous vitreal adhesions, epiretinal membrane (ERM), or both, and six eyes (12.5%) had questionable VMIA. OCT in general was 1.94 times more sensitive than traditional techniques combined in detecting VMIA (P = .00003). The number of focal laser sessions and diffuse FA leakage were not associated with an increased prevalence of VMIA (P = .13 and P = .47, respectively). CONCLUSIONS: This study demonstrates a high prevalence of VMIA in eyes with PDME after focal laser treatment and underscores the superiority of OCT in detecting these abnormalities. OCT evaluation of eyes with PDME may be helpful in identifying VMIA, which may impact treatment selection and patient subgroup stratification.     

Optical coherence tomography for assessment of diabetic macular edema

Optical coherence tomography (OCT) is a noninvasive objective diagnostic technique that has become a powerful method for the clinical assessment of diabetic macular edema. It is a very useful imaging technique to diagnose and follow-up diabetic macular edema (DME). The present paper aims to present an overview of the principles, progress, and uses of OCT in the diagnosis and management of DME.     

光学相干断层扫描技术在糖尿病黄斑水肿的应用

光学相干断层扫描技术是一种高分辨率,非接触性的生物组织成像技术,能在活体上动态的观察一些眼底疾病发生发展的过程,近年来光学相干断层扫描技术在对糖尿病黄斑水肿的临床诊治和研究工作中发挥了很大的作用。本文就光学相干断层扫描技术对糖尿病黄斑水肿的应用作一综述。     

黄斑水肿的光相干断层扫描分析

目的 观察黄斑水肿的光相干断层扫描（OCT）图像特征；探讨黄斑中心凹厚度与最佳矫正视力之间的关系。 方法 对50例正常对照者以及47例54只经直接、间接检眼镜、三面镜及荧光素眼底血管造影（FFA）诊断为黄斑水肿的患眼进行OCT检查，通过黄斑中心凹的水平或垂直方向线性扫描，测量黄斑中心凹的厚度，对比分析两组受检者的黄斑形态及中心凹厚度值，根据形态学特点对黄斑水肿者的OCT图像进行分类并将其中心凹厚度与其最佳矫正视力进行相关分析。 结果 正常对照组与黄斑水肿组黄斑形态及中心凹厚度差异有显著性的意义。黄斑水肿患眼的OCT图像表现为3种特征，20只眼表现为黄斑区视网膜海绵样肿胀，占37.1%；26只眼表现为黄斑囊样水肿，占48.1%；8只眼表现为浆液性视网膜神经上皮脱离，占14.8%。黄斑水肿者黄斑中心凹厚度与其最佳矫正视力呈负相关（r=－0.569, P=0.000）。 结论 黄斑水肿的OCT图像主要包括视网膜海绵样肿胀、黄斑囊样水肿及神经上皮浆液性脱离。黄斑水肿患者的黄斑中心凹厚度明显增厚，黄斑中心凹厚度越厚，视力越差。 （中华眼底病杂志，2004，20：152-155）     

Optical coherence tomography analysis of patients with untreated diabetic macular edema

Graefe's Archive for Clinical and Experimental Ophthalmology - Diabetic macular edema (DME) is a major cause of vision loss. Diabetes patients with mild macular edema and good visual acuity are...     

Perifoveal microcirculation before and after vitrectomy for diabetic cystoid macular edema

PURPOSE: To quantify the perifoveal microcirculation in diabetic eyes before and after successful vitreous surgery for cystoid macular edema without posterior vitreous detachment, and to determine whether improvement in perifoveal microcirculation is associated with improvement in postoperative visual acuity. METHODS: In a prospective study, vitreous surgery was performed on 11 eyes of nine consecutive diabetic patients with cystoid macular edema, and their mean perifoveal capillary blood flow velocity was measured by fluorescein angiography with a scanning laser ophthalmoscope. Visual acuity was measured preoperatively and postoperatively, and the results were converted to the logarithm of the minimum angle of resolution (logMAR). The correlation between changes in logMAR visual acuity and capillary blood flow velocity was evaluated. RESULTS: In all nine eyes of seven patients with successful vitreous surgery, the cystoid macular edema resolved within 6 months after surgery, and the mean capillary blood flow velocity was significantly increased compared with that before surgery (2.19 mm per second versus 2.68 mm per second, P =.021); the changes in capillary blood flow velocity were significantly correlated with the changes in the logMAR visual acuity (P =.024). CONCLUSIONS: Vitreous surgery may improve perifoveal microcirculation in the eyes of diabetic patients with cystoid macular edema and resolve the macular edema. Improvement of perifoveal microcirculation may be an important factor affecting visual outcome.     

Optical coherence tomography assessment of the vitreoretinal relationship in diabetic macular edema

PURPOSE: To study the vitreoretinal relationship in diabetic patients with and without diabetic macular edema (DME) using optical coherence tomography. DESIGN: Retrospective case-control study. METHODS: setting: Institutional practice. patients: Thirty-five consecutive diabetic patients (49 eyes) with DME and 35 sex- and age-matched diabetic control patients without DME (49 eyes). observation procedure: All patients had Early Treatment Diabetic Retinopathy Study visual acuity measurement and biomicroscopic examination of the vitreoretinal interface. OCT was performed to obtain cross-sectional images of the vitreoretinal interface of the macular region. Posterior vitreous detachment (PVD) was staged from 0 to 3 as follows: stage 0: absence of PVD; stage 1: perifoveolar PVD with foveolar attachment; stage 2: incomplete PVD with residual attachment to the optic nerve; and stage 3: complete PVD. Retinal thickness was measured using OCT mapping software in all cases. main outcome measures: Prevalence of the different PVD stages in both groups of eyes. RESULTS: The mean age of the patients was 60 years in both groups. Of the eyes with macular edema, 19 (38.8%) were stage 0, 26 (53.0%) stage 1, 1 (2.0%) was stage 2, and 3 (6.2%) were stage 3. In eyes without DME, the corresponding figures were, respectively, 34 (69.4%), 11 (22.4%), 1 (2.0%), and 3 (6.2%). The prevalence of perifoveolar PVD with foveolar attachment was significantly higher in the group of eyes with DME (P =.006). CONCLUSIONS: These results show the high prevalence of perifoveolar PVD with foveolar attachment in diabetic patients with macular edema. Even though PVD is not the main factor involved in the pathogenesis of DME, perifoveolar PVD may have a role in the development of this complication.     

Optical coherence tomography characteristics of taxane-induced macular edema and other multimodal imaging findings

Graefe's Archive for Clinical and Experimental Ophthalmology - To identify common optical coherence tomography (OCT) characteristics of taxane-related CME (T-CME) to differentiate it from CME...     

Assessment of macular function by multifocal electroretinogram in diabetic macular edema before and after vitrectomy

The purpose of this study was to assess the effects of vitrectomy on retinal function in macular and paramacualr areas in patients with diabetic macular edema (DME). Ten eyes of 9 patients with successful vitrectomy for DME were evaluated by multifocal electroretinogram (mfERG), optical coherence tomography (OCT), and visual acuity preoperatively and 1, 2, 3, 4, 5 and 6 months postoperatively. Compared with pretreatment values, the response of the positive wave (P1) in macular and paramacular areas tended to decrease in latency from the second postoperative month, and increase in amplitude at the third postoperative month. There was no significant change in response of the negative wave (N1). The tendency in the change of macular function is coincident with that of macular morphology. Therefore, The multifocal ERG may provide objective criteria for the functional evaluation of DME before and after vitrectomy.     

Optical coherence tomography after laser photocoagulation for clinically significant macular edema

BACKGROUND AND OBJECTIVE: To demonstrate the utility of optical coherence tomography (OCT) for documenting an early response to laser photocoagulation in clinically significant macular edema (CSME) secondary to diabetes. PATIENTS AND METHODS: Five eyes of four patients were selected for review based on the diagnosis of CSME. All eyes had a clinical diagnosis of CSME based on slit lamp biomicroscopy. All eyes underwent focal/grid laser photocoagulation to areas of retinal thickening detected by OCT and clinical exam. Pre and post-treatment optical coherence tomograms were obtained for all patients. RESULTS: All eyes selected for review had an early positive response to focal laser photocoagulation. OCT was useful for demonstrating areas of retinal thickening prior to laser treatment. Serial macular maps demonstrated the resolution of retinal thickening after laser photocoagulation in all eyes. CONCLUSION: OCT is a useful tool for evaluating and documenting CSME both before and after focal/grid laser photocoagulation. OCT is capable of detecting an early positive response to photocoagulation for macular edema.     

Optical coherence tomography findings in occult macular dystrophy

PURPOSE: To determine the basis for unexplained visual acuity loss in selected patients. DESIGN: Observational study of patients with unexplained reduced visual acuity. METHODS: We used optical coherence tomography (OCT) to evaluate foveal structure in eight patients. These patients had corrected visual acuities of 20/25 to count fingers in one or both eyes and a normal ocular examination. We recorded foveal cone electroretinograms (ERGs) as an objective measure of foveal function. RESULTS: Seven patients showed reduced foveal thickness associated with thinning of the outer nuclear layer (ONL), and five of these patients also had reduced foveal cone ERGs. One patient had normal tomograms and reduced foveal ERGs. CONCLUSIONS: Unexplained reductions in visual acuity may result from photoreceptor loss or foveal malfunction without photoreceptor loss, which are indicators of occult macular dystrophy. OCT and the foveal cone ERG together appear to be sufficient to identify the basis for visual acuity loss in these patients.     

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.