Abstract
Purpose: To compare the detection rates of optical coherence tomography (OCT) and fluorescein angiography (FA) in a diabetic macular edema (DME) and the severity of diabetic retinopathy in both color fundus images (CFI) and FA, and to investigate the predictive factors in macular leakages in FA.Methods: This was a retrospective study, and a total of 132 eyes of 77 patients with diabetic retinopathy were enrolled. Macular OCT, FA, and CFI were reviewed and measured. Central foveal thickness was also measured.Results: The severity of diabetic retinopathy in FA was significantly higher than that in CFI (p < 0.001). OCT detected 26 eyes with DMEs, which included the following: 13 eyes with cystoid macular edemas; 13 eyes with serous retinal detachments; 11 eyes with diffuse retinal thickening; 4 eyes with vitreomacular interface abnormalities. In contrast, 72 out of 132 eyes (54.5%) showed macular leakages in FA, which was significantly higher than that detected by OCT (p < 0.001). Compared with FA, the sensitivity and the specificity of OCT in detecting DMEs were 30.6 and 93.3%, respectively. However, central foveal thickness was not significantly different between the patients with non-clinically significant macular edema (CSME, 253.1 ± 26.95 μm) and slight CSME (270.9 ± 37.11 μm, p = 0.204). The mean central foveal thickness in diabetic macular edema (FA) eyes was 271.8 ± 66.02 μm, which was significantly higher than that (253. ± 25.21 μm) in non-DME (FA) eyes (p = 0.039). The central foveal thickness in DME (FA) eyes was significantly lower than that in eyes with DME (OCT) (p = 0.014). After adjusting for age and sex, a logistic regression analysis showed that the classification of diabetic retinopathy in FA was positively associated with macular leakage in FA (p < 0.001).Conclusions: The severity of diabetic retinopathy is underestimated in CFI compared with that in FA. FA can detect latent DMEs, which appeared normal on OCT. The central foveal thickness is not a sensitive parameter for detecting latent DMEs.
Highlights
A diabetic macular edema (DME) can occur at any stage of diabetic retinopathy (DR) and is the main cause for vision loss in patients with diabetes [1]
Using the International Clinical Diabetic Retinopathy Disease Severity Scale [19], we evaluated the severity of DR in color fundus images (CFI) and fundus angiography (FA), which was based on previous studies [20, 21]
The results showed that the area under the receiveroperating characteristic (AUROC) for the classification of DR in CFI [0.709 ± 0.046, p < 0.001, 95% confidence intervals (CIs) (0.620, 0.799)], clinically significant macular edema (CSME) [0.635 ± 0.048, p = 0.008, 95% CI (0.541, 0.729)], and DME [0.619 ± 0.048, p = 0.018, 95% CI (0.524, 0.714)] and the classification of DR in FA [0.875 ± 0.031, p < 0.001, 95% CI (0.813, 0.936)] significantly predicted macular leakages in FA, compared with CFI [0.573 ± 0.05, p = 0.152, 95% CI (0.475, 0.67); Figure 3]
Summary
The severity of diabetic retinopathy in FA was significantly higher than that in CFI (p < 0.001). 72 out of 132 eyes (54.5%) showed macular leakages in FA, which was significantly higher than that detected by OCT (p < 0.001). Central foveal thickness was not significantly different between the patients with non-clinically significant macular edema (CSME, 253.1 ± 26.95 μm) and slight CSME (270.9 ± 37.11 μm, p = 0.204). The mean central foveal thickness in diabetic macular edema (FA) eyes was 271.8 ± 66.02 μm, which was significantly higher than that After adjusting for age and sex, a logistic regression analysis showed that the classification of diabetic retinopathy in FA was positively associated with macular leakage in FA (p < 0.001)
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