Quantitative assessment of retinal thickness in diabetic patients with and without clinically significant macular edema using optical coherence tomography

PURPOSE: To assess patients with diabetic macular edema quantitatively using optical coherence tomography (OCT). METHODS: OCT was performed in 14 eyes with diabetic retinopathy and ophthalmoscopic evidence of clinically significant macular edema (CSME) and in 19 diabetic eyes without CSME. Retinal thickness was computed from the tomograms at fovea and other 36 locations throughout the macula. RESULTS: The mean +/- standard deviation foveal thickness was 255.6 +/- 138.9 microm in eyes with CSME, and 174.6 +/- 38.2 microm in eyes without CSME (p = 0.051). Within 2000 microm of the center of the macula, eyes with CSME had significantly thicker retina in the inferior quadrant than those without CSME (p < 0.01). The foveal thickness was correlated with logMAR visual acuity (gamma = 0.68, p < 0.01). OCT identified sponge-like retinal swelling and/or cystoid macular edema in 11 (58%) eyes without CSME, and in 12 (86%) eyes with CSME. CONCLUSIONS: Criteria of CSME seem to be insufficient in really identifying macular edema. OCT may be more sensitive than a clinical examination in assessing diabetic macular edema and is a quantitative tool for documenting changes in macular thickening.     

Retinal thickness in diabetic retinopathy: comparison of optical coherence tomography, the retinal thickness analyzer, and fundus photography

BACKGROUND: Optical coherence tomography (OCT) and the retinal thickness analyzer (RTA) have proved their ability to measure retinal thickness in healthy subjects and diabetics reliably. In the present study, both techniques were compared for the same study population of diabetic patients, and the findings were related to macular edema shown by stereo fundus photography (SFP). METHODS: Maculas of 124 eyes from 69 patients with diabetes mellitus were examined with OCT and the RTA. Measurements of retinal thickness were compared with signs of macular edema shown by SFP. For each eye, nine different sectors were analyzed (a foveal sector, four parafoveal sectors, and four extrafoveal sectors). Thirteen eyes with a normal macula served as controls. Sensitivity and specificity of detecting clinically significant macular edema (CSME) were calculated. RESULTS: Of 111 eyes, 64 showed signs of CSME by SFP. Mean retinal thickness +/- SD of the foveal sector was 249 +/- 104 microm by RTA and 295 +/- 124 microm by OCT measurements. There was a moderate overall correlation between OCT and the RTA (r = 0.66). The correlation was best in the foveal sector (r = 0.82). Overall correlation with SFP was better for OCT (r = 0.77) than for the RTA (r = 0.62). Sensitivity of detecting CSME was consistently higher with OCT, while the RTA showed higher specificity. CONCLUSION: Both measuring techniques yielded similar results when examining eyes of patients with diabetes, although absolute values differed. OCT seems to be more suitable in the clinical screening for macular edema due to its high sensitivity (>90%) with appropriate analysis parameters. The RTA is more prone to erroneous or missing thickness readings particularly under difficult measuring conditions.     

A method of reporting macular edema after cataract surgery using optical coherence tomography

OBJECTIVE: To validate a method of reporting postcataract macular edema (ME) using optical coherence tomography (OCT). METHODS:: Data were analyzed for 130 eyes followed prospectively for ME after uncomplicated cataract surgery. Each eye underwent OCT within 4 weeks before surgery and at 1 month and 3 months after surgery. ME was defined by observation of cystoid changes by OCT. RESULTS: Incidence of ME was 14% (95% confidence interval, 8-20). Average increase in baseline center point thickness (CPT) +/- SD at 1 month for eyes with and without ME was 202 +/- 113 microm and 8 +/- 19 microm, respectively (P < 0.001), which resulted in a 1-letter loss (-0.02 logMAR [logarithm of the minimum angle of resolution]) and a 3-line gain (0.29 logMAR) in vision, respectively (P < 0.001). Percent change in baseline CPT +/- SD for eyes with and without ME was 115 +/- 67% and 6 +/- 11%, respectively (P < 0.001). A > or =40% increase in baseline CPT accurately determined 100% of eyes with ME and 99% of eyes without ME. CONCLUSIONS: A > or =40% increase in baseline CPT, determined by OCT, offers a valid and objective method of reporting clinically relevant postcataract ME. Standardized reporting of postcataract ME would allow objective assessment and comparison of treatment outcomes among clinical studies.     

Retinal thickness study with optical coherence tomography in patients with diabetes

PURPOSE: To quantitatively assess retinal thickness by optical coherence tomography (OCT) in normal subjects and patients with diabetes. This study was intended to determine which retinal thickness value measured with OCT best discriminates between diabetic eyes, with and without macular edema. METHODS: OCT retinal thickness was measured by a manual technique in a total of 26 healthy volunteers (44 control eyes) and 85 patients with diabetes (148 eyes) with the clinical diagnosis of no diabetic retinopathy (45 eyes), nonproliferative diabetic retinopathy without clinically significant macular edema (CSME; 54 eyes), proliferative diabetic retinopathy without CSME (21 eyes), and 28 eyes with diabetic retinopathy with CSME. Independent predictors of the presence of CSME were quantified by using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were generated to evaluate and compare the predictor variables. The correlation of retinal thickness measurements and visual acuity was calculated. RESULTS: There were statistically significant differences in foveal thickness between control eyes and all the other eye groups (P = 0.001). Diabetic eyes with CSME had a statistically significant greater thickness in each of the areas compared with the other groups. In a multivariate logistic regression model, foveal thickness was a strong and independent predictor of CSME (odds ratio [OR], 1.037; 95% confidence interval [CI] 1.02-1.05). The area under the ROC curve of this predictor variable was 0.94 (P = 0.001). For a cutoff point of 180 microm, the sensitivity was 93%, and specificity was 75%. Foveal thickness correlated with visual acuity in a log minimum angle of resolution (logMAR) scale (Spearman's rho = 0.9, P = 0.001). CONCLUSIONS: These results suggest that foveal thickening over 180 microm measured by OCT may be useful for the early detection of macular thickening and may be an indicator for a closer follow-up of the patient with diabetes.     

Arteriovenous sheathotomy for persistent macular edema in branch retinal vein occlusion

PURPOSE: To evaluate the efficacy of arteriovenous (AV) sheathotomy with internal limiting membrane peeling for persistent or recurrent macular edema after intravitreal triamcinolone injection and/or laser photocoagulation in branch retinal vein occlusion. METHODS: Twenty-two eyes with branch retinal vein occlusion (BRVO) with recurrent macular edema underwent vitrectomy with AV sheathotomy and internal limiting membrane peeling. All eyes had previous intravitreal triamcinolone injection and/or laser photocoagulation for macular edema. The best corrected visual acuity (BCVA), fluorescein angiography and optical coherence tomography (OCT) before and after surgery were compared. RESULTS: The mean preoperative BCVA (log MAR) were 0.79 +/- 0.29 and postoperative BCVA (log MAR) at 3 months was 0.57 +/- 0.33. And improvement of visual acuity > or = 2 lines was observed in 10 eyes (45%). The mean preoperative fovea thickness measured by OCT was 595.22 +/- 76.83 microm (510-737 microm) and postoperative fovea thickness was 217.60 +/- 47.33 microm (164-285 microm). CONCLUSIONS: Vitrectomy with AV sheathotomy can be one treatment option for the patients with recurrent macular edema in BRVO.     

Can optical coherence tomography predict the outcome of laser photocoagulation for diabetic macular edema?

BACKGROUND AND OBJECTIVE: To assess the outcome of laser photocoagulation in patients with diabetic macular edema. PATIENTS AND METHODS: Forty-seven patients (51 eyes) with clinically significant macular edema (CSME) undergoing grid laser photocoagulation were included. Clinical examination and optical coherence tomography (OCT) were performed at baseline and 3 to 4 months after treatment. The central foveal thickness, mean inner macular thickness (average retinal thickness in fovea and inner macular circle), and mean macular thickness were calculated. Based on the greatest OCT thickness at baseline, patients were grouped according to mild (< 300 microm; Group 1), moderate (300 to 399 microm; Group 2), and severe (> or = 400 microm; Group 3) macular edema. RESULTS: Group 2 showed significant reductions in central foveal thickness (23 microm, P = .02), mean inner macular thickness (18 microm, P = .02), and mean macular thickness (9 microm, P = .04) with slight improvement in visual acuity. Groups 1 and 3 did not show any significant change in macular thickness values and there was a statistically insignificant worsening of visual acuity in these groups. CONCLUSIONS: Patients with moderate macular thickening of 300 to 400 microm benefit most from laser treatment. OCT may help in choosing the appropriate treatment for CSME based on the degree of macular thickening. Long-term studies are warranted to confirm these findings.     

Intravitreal triamcinolone for refractory diabetic macular edema

PURPOSE: To determine if intravitreal injection of triamcinolone acetonide is safe and effective in treating diabetic macular edema unresponsive to prior laser photocoagulation. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Sixteen eyes with clinically significant diabetic macular edema (CSME) that failed to respond to at least two previous sessions of laser photocoagulation. METHODS: Eyes were diagnosed with CSME and treated with at least two sessions of laser photocoagulation according to Early Treatment Diabetic Retinopathy Study guidelines. At least 6 months after initial laser therapy, the response was measured by clinical examination and optical coherence tomography (OCT). Eyes with a residual central macular thickness of more than 300 microm (normal, 200 microm) and visual loss from baseline were offered intravitreal injection of 4 mg triamcinolone acetonide. The visual and anatomic responses were observed as well as complications related to the injection procedure and corticosteroid medication. MAIN OUTCOME MEASURES: Visual acuity and quantitative change in OCT macular thickening were assessed. Potential complications were monitored, including intraocular pressure response, cataract progression, retinal detachment, vitreous hemorrhage, and endophthalmitis. RESULTS: All patients completed 3 months of follow-up, and 8 of 16 patients (50%) completed 6 or more months of follow-up. Mean improvement in visual acuity measured 2.4, 2.4, and 1.3 Snellen lines at the 1-, 3-, and 6-month follow-up intervals, respectively. The central macular thickness as measured by OCT decreased by 55%, 57.5%, and 38%, respectively, over these same intervals from an initial pretreatment mean of 540.3 microm (+/-96.3 microm). Intraocular pressure exceeded 21 mmHg in 5, 3, and 1 eye(s), respectively, during these intervals. One eye exhibited cataract progression at 6 months. No other complications were noted over a mean follow-up of 6.2 months. Reinjection was performed in 3 of 8 eyes after 6 months because of recurrence of macular edema. CONCLUSIONS: Intravitreal triamcinolone is a promising therapeutic method for diabetic macular edema that fails to respond to conventional laser photocoagulation. Complications do not appear to be prohibitive. Further study is warranted to assess the long-term efficacy and safety, and the need for retreatment.     

Diurnal variation in clinically significant diabetic macular edema measured by the Stratus OCT

PURPOSE: To investigate diurnal variation in clinically significant macular edema (CSME) using the Stratus OCT (Carl Zeiss Meditec). METHODS: Fifteen eyes of 15 diabetic patients with CSME and 10 healthy subjects (controls) underwent four optical coherence tomography (OCT) measurements of macular thickness with the fast macular thickness mapping protocol of the Stratus OCT at 9 am, 12 pm, 3 pm, and 6 pm. Early Treatment Diabetic Retinopathy Study visual acuity and refraction data were also collected at each time. Retinal thickness measurements from each of the nine macular Early Treatment Diabetic Retinopathy Study areas of the retina map, visual acuity, and refraction were plotted over time. RESULTS: Mean retinal thickness remained unchanged in all retinal sectors over the course of the day for the controls and the 6 diabetic patients with a baseline foveal thickness of <300 mum, and it significantly decreased in 7 of the 9 retinal sectors for the 9 diabetic patients with a baseline foveal thickness of > or =300 microm (ANOVA model for repeated measures). In these patients, the mean initial foveal thickening +/- SD of 211 +/- 104 microm was reduced by an average of 6.1%, 15.2%, and 21.2% at 12 pm, 3 pm, and 6 pm, respectively. Two of these nine patients also had an increase in visual acuity without change in refraction. There were no changes in refractive errors over the course of the study in the two groups. A positive correlation between initial central thickening and decrease in thickness was found (r = 0.732; P = 0.002). CONCLUSION: This study suggests that macular thickening, as measured by the Stratus OCT, may spontaneously decrease in some patients with more severe CSME over the course of the day, and it confirms previous findings. However, in our study, the entity of this decline was relatively small and not relevant from a clinical standpoint.     

Retinal thickness in diabetic retinopathy: a study using optical coherence tomography (OCT)

BACKGROUND AND OBJECTIVE: The authors conducted a controlled study to quantify macular retinal thickness in diabetic retinopathy using optical coherence tomography (OCT) as an objective and noninvasive tool. The relationship between retinal thickness and standard methods of evaluating macular edema was investigated. PATIENTS AND METHODS: A total of 136 patients in different stages of diabetic retinopathy were examined with OCT. In addition, fluorescein angiograms as well as standard eye examinations were conducted. The control group consisted of 30 individuals with a normal macula. RESULTS: In the controls, retinal thickness was 153 +/- 15 microm in the fovea, 249 +/- 19 microm in the temporal parafoveal region, and 268 +/- 20 microm in the nasal parafoveal region. In diabetic patients, retinal thickness was increased to 307 +/- 136 microm in the fovea, 337 +/- 88 microm in the temporal retina, and 353 +/- 95 microm in the nasal retina, respectively. The differences between diabetics and controls were highly significant (P < 0.001). Retinal thickening correlated with fluorescein leakage in the angiograms to some extent. There was an intermediate correlation between retinal thickness and visual acuity, particularly in patients without macular ischemia. Sensitivity of detecting clinically significant macular edema by measuring foveal retinal thickness was 89% and specificity was 96%. CONCLUSION: Optical coherence tomography allows us to quantify retinal thickness in diabetic retinopathy with excellent reproducibility. OCT is able to detect sight-threatening macular edema with great reliability.     

Efficacy of various laser wavelengths in the treatment of clinically significant macular edema in diabetics

BACKGROUND AND OBJECTIVE: To compare various laser wavelengths: argon green (514 nm), vs krypton red (647 nm), vs frequency doubled Nd:YAG (532 nm), and vs diode (810 nm), for laser photocoagulation treatment in clinically significant macular edema (CSME) in diabetics. PATIENTS AND METHODS: Four different wavelengths were used to sequentially treat 271 eyes of 164 diabetic patients with CSME. Follow up was conducted for a minimum of 6 months (9.8 +/- 1.3 months). Retreatment was performed if residual edema involving the foveal avascular zone persisted at 3 months. RESULTS: Reduction/elimination of CSME was observed in 93.3% of argon-treated eyes, 88.5% in krypton red group, 92.9% with frequency doubled Nd:YAG, and 84.8% with diode laser with no statistically significant difference between the groups (P > 0.05 for all groups). The number of eyes requiring retreatment was highest with the diode laser having 44.3% of eyes requiring retreatment and least with frequency doubled Nd:YAG having only 15.5% of eyes requiring retreatment (P = 0.0002). CONCLUSIONS: All lasers are equally effective in reducing/eliminating CSME. However, Nd:YAG may have an advantage because of requiring fewer retreatments.     

Enhanced depth imaging optical coherence tomography in type 2 diabetes

Purpose. To investigate the changes in macular choroidal thickness in eyes with various stages of diabetic retinopathy, using enhanced depth imaging optical coherence tomography (EDI OCT). Methods. Sixty-three consecutive diabetic patients-who presented without diabetic retinopathy (NDR); with diabetic retinopathy (nonproliferative diabetic retinopathy [NPDR]) and no clinically significant macular edema (CSME-); or with NDPR and clinically significant macular edema (CSME+)-underwent EDI OCT. Twenty-one age- and sex-matched healthy subjects (21 eyes) also underwent EDI OCT. Results. A total of 63 eyes of 63 consecutive diabetic patients (26 female [41.2%]; mean age 65 ± 9 years, range 48-83 years) were included in the analysis. Mean best-corrected visual acuity was 0.13 ± 0.25 LogMAR (range 0-1). Mean CMT was 272.5 ± 16.2 μm in 21 NDR eyes, 294.5 ± 23.5 μm in 21 NPDR/CSME- eyes, and 385.6 ± 75.1 μm in 21 NPDR/CSME+ eyes. There was no difference in mean subfoveal choroidal thickness among each diabetic group (238.4 ± 47.9 μm [NDR], 207.0 ± 55.9 μm [NPDR/CSME-], 190.8 ± 48.4 μm [NPDR/CSME+]; P = 0.23). The mean subfoveal choroidal thickness was significantly reduced in each diabetic group compared with the control group (309.8 ± 58.5 μm, P < 0.001). Conclusions. In diabetic eyes, there is an overall thinning of the choroid on EDI OCT. A decreased choroidal thickness may lead to tissue hypoxia and consequently increase the level of VEGF, resulting in the breakdown of the blood-retinal barrier and development of macular edema.     

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.     

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.     

糖尿病患者有临床意义黄斑水肿的OCT临床分型

目的 用光学相干断层扫描(OCT)研究糖尿病患者有临床意义的黄斑水肿(CSME)的临床分型.方法 对75例患者104只眼,经裂隙灯三面镜检查诊断为糖尿病性视网膜病变Ⅰ-Ⅳ期(包括Ⅳ期)者,行眼底荧光血管造影(FFA)及黄斑区光学相干断层扫描(OCT)检查,根据1985年CSME诊断标准诊断为CSME,对其OCT图像进行分型.结果 糖尿病患者CSME的OCT分型分为五型:弥漫性黄斑水肿占37.5%(39/104),黄斑囊样水肿占20.2%(211104),弥漫性黄斑水肿伴浆液性神经上皮层脱离占18.3%(191104),黄斑前膜伴神经上皮层水肿占13.5%(14/104),后玻璃体牵引伴黄斑水肿10.6%(11/104);另有黄斑前膜伴裂孔形成1例.结论 OCT对CSME的诊断以及治疗后的随访有重要的价值,是临床观察CSME必不可少的检查手段.     

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.     

Diabetic macular edema: correlation between microperimetry and optical coherence tomography findings

PURPOSE: To compare the changes in macular sensitivity (microperimetry) and macular thickness with different degrees of diabetic macular edema. METHODS: Sixty-one eyes of 32 consecutive diabetic patients were included in this cross-sectional study. All included eyes underwent functional and morphologic examination of the macular area. Best corrected visual acuity (ETDRS charts), macular sensitivity, and macular thickness were quantified. Lesion-related macular sensitivity and retinal fixation were investigated with an advanced, automatic microperimeter. Optical coherence tomography (OCT) was used to quantify macular thickness. RESULTS: The 61 included eyes were graded, by two retinal specialists, for diabetic macular edema as follows: 16 were graded as no macular edema (NE), 30 as non-clinically significant macular edema (NCSME), and 15 as clinically significant macular edema (CSME). Macular thickness significantly increased from the NE to the CSME group (P<0.0001), whereas macular sensitivity significantly decreased from the NE to the CSME group (P<0.0021). A significant correlation coefficient was noted between retinal sensitivity and normalized macular thickness (r=-0.37, P<0.0001). Linear regression analysis showed a decrease of 0.83 dB (P<0.0001) for every 10% of deviation of retinal thickness from normal values. Visual acuity and central macular sensitivity correlated significantly in the NCSME group (r=-0.6, P=0.0008), but not in the NE (r=-0.144, P=0.6) or in the CSME (r=-0.46, P=0.11) groups. CONCLUSIONS: Macular edema may be better documented by adding macular sensitivity mapping by microperimetry to macular thickness measurement by OCT and visual acuity determination because macular sensitivity seems to be a relevant explanatory variable of visual function, independent of macular thickness data. Moreover, microperimetry may be of value in predicting the outcome of diabetic macular edema, because it incorporates a functional measure that may supplement the predictive value of OCT and visual acuity.     

Patterns of macular edema in patients with uveitis: qualitative and quantitative assessment using optical coherence tomography

PURPOSE: To describe the morphologic characteristics of uveitic macular edema by the use of optical coherence tomography (OCT) and to investigate the correlation between tomographic features and visual acuity (VA). DESIGN: Cross-sectional study. PARTICIPANTS: Seventy consecutive patients with uveitis in a university-based practice with a clinical diagnosis of macular edema in at least one eye. Inclusion criteria were: (1) verification of macular edema by OCT, (2) adequate media clarity for fundus visualization, and (3) absence of coexisting ocular disease limiting visual potential. METHODS: Complete ophthalmic examination: best-corrected Snellen VA, slit-lamp examination, fundus biomicroscopy, indirect ophthalmoscopy, and OCT. Fluorescein angiography was performed in selected cases. MAIN OUTCOME MEASURES: Best-corrected Snellen VA and tomographic features of the macula, including macular thickness measurement and correlation of macular thickness with VA. RESULTS: Eighty-four eyes of 60 patients met the inclusion criteria. The mean VA (Snellen test) was 20/36. There were 3 patterns of macular edema: diffuse macular edema (DME), cystoid macular edema (CME), and serous retinal detachment (RD). Serous retinal detachment was detected in 17 eyes (20.2%). Patients were classified into the following groups: DME (46 eyes, 54.8%), CME (21 eyes, 25%), DME and RD (5 eyes, 5.9%), CME and RD (12 eyes, 14.3%). Epiretinal membrane was detected by OCT in 34 eyes (40.5%). Eight eyes (9.5%) demonstrated vitreomacular traction. The mean retinal thickness at the central fovea was 333+/-171 microm (mean +/- standard deviation). Macular edema was located mainly in the outer retinal layers. Eyes with CME had significantly greater retinal thickness measurements than eyes with DME (P<0.001). Multivariate analysis revealed that VA was negatively correlated with increased macular thickness, presence of CME, and RD (P<0.05). CONCLUSIONS: Optical coherence tomography demonstrated 3 patterns of macular edema in patients with uveitis: DME, CME, and RD. Epiretinal membrane coexisted in a significant percentage of patients. In patients with uveitis with clear media, the morphologic features of macular edema and macular thickness correlated with VA.     

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）     

Serial optical coherence tomography of subthreshold diode laser micropulse photocoagulation for diabetic macular edema.

BACKGROUND AND OBJECTIVE: To use serial optical coherence tomography (OCT) to evaluate low-intensity, high-density subthreshold diode laser micropulse photocoagulation treatment of clinically significant diabetic macular edema. PATIENTS AND METHODS: Eighteen consecutive eyes of 14 patients with clinically significant diabetic macular edema and a minimum foveal thickness of 223 microm or greater were prospectively evaluated by OCT preoperatively and 1, 4, and 12 weeks following treatment. RESULTS: Overall, estimated macular edema 3 months postoperatively (minimum foveal thickness--223 microm) was reduced a mean of 24% (P = .02). Eleven eyes treated for recurrent or persistent clinically significant diabetic macular edema following prior treatment more than 3 months before study entry were most improved, with a mean reduction in estimated macular edema 3 months postoperatively of 59%. No treatment complications were observed. No patient demonstrated laser lesions following treatment. CONCLUSIONS: Low-intensity, high-density subthreshold diode laser micropulse photocoagulation can reduce or eliminate clinically significant diabetic macular edema measured by OCT. Further study is warranted.     

Prospective evaluation of intravitreal triamcinolone acetonide injection in macular edema associated with retinal vascular disorders

PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity and macular thickness using optical coherence tomography (OCT) in macular edema associated with various retinal vascular disorders. METHODS: This prospective nonrandomized clinical interventional study included 81 eyes (76 patients) comprised of Group I, 57 eyes (51 patients) with diabetic macular edema; Group II, 10 eyes (10 patients) with branch retinal vein occlusion; and Group III, 13 eyes (13 patients) with central retinal vein occlusion. All eyes received an intravitreal injection of 4 mg triamcinolone acetonide (with the solvent) in the operation theater under sterile conditions. RESULTS: Mean preinjection central macular thickness was 531.84+/-132 microm in Group I, 458.4+/-149 microm in Group II, and 750.81+/-148 microm in Group III. All groups showed a statistically significant decrease in mean central macular thickness at 1 month (300.7+/-119 microm in Group I, 218.2+/-99 microm in Group II, and 210.5 +/-56 microm in Group III) and 3 months (253.19+/-109 microm in Group I, 187+/-47 microm in Group II, and 182+/-50 microm in Group III) after injection (p < 0.05). Mean follow-up was 22+/-2.4 weeks. Mean visual acuity increased in all three groups (preoperative visual acuity in Group I, 1.2+/-0.4 logMAR units; Group II, 1.24+/-0.5 logMAR units; Group III, 1.1+/-0.4 logMAR units; 1 month postinjection in Group I, 0.88+/-0.3 logMAR units; Group II, 0.67+/-0.3 logMAR units; Group III, 0.86+/-0.4 logMAR units; 3 months postinjection in Group I, 0.84+/-0.4 logMAR units; Group II, 0.59+/-0.3 logMAR units; Group III, 0.82+/-0.5 logMAR units) (p < 0.05). Forty-one eyes completed 6 months and 20 eyes completed 9 months follow-up. Twelve of 20 (41%) eyes in Group I, 2/6 (33%) eyes in Group II, 3/6 (50%) eyes in Group III, and 8/15 (53%) eyes in Group I, 1/3 (33%) eyes in Group II, and 2/2 (100%) eyes in Group III developed recurrence of macular edema with worsening of visual acuity at 6 and 9 months, respectively. Thirty-three (40.7%) eyes developed IOP elevation (at least one reading > 24 mmHg). One eye developed infective endophthalmitis. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide may be considered as an effective treatment for reducing macular thickening due to diffuse diabetic macular edema, venous occlusion associated macular edema, and may result in increase in visual acuity at least in the short term. Further follow-up and analysis is required to demonstrate its long-term efficacy.