Diffuse Retinal Thickening Research Articles

The Responses of Different Types of Diabetic Macular Edema after Three Loading Doses of Anti-vascular Growth Factor: Outcomes in Two Medical Centers

Background: Diabetic macular edema (DME) is currently treated by anti-vascular endothelial growth factor (anti-VEGF). Aim: The aim of this study was to evaluate the effect of intravitreal anti-VEGF in different types of DME classified by optical coherence tomography (OCT). Methods: This retrospective study included 161 treatment-naive eyes (116 patients) diagnosed with DME in two tertiary medical centers, which were classified into three groups according to initial OCT finding: diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). All eyes received three monthly loading doses of anti-VEGF. Primary and secondary outcomes were the improvement of best-corrected visual acuity (BCVA) and the decrease of central foveal thickness (CFT) on OCT, respectively. Results: Among the three groups, there was no significant difference in baseline BCVA (P = 0.137); however, the SRD group had the thickest baseline CFT (P < 0.001). After three loading doses of anti-VEGF, the BCVA of all three groups improved from baseline (DRT vs. CME vs. SRD, P = 0.0002, P < 0.0001, and P < 0.0001, respectively), while the SRD group seemed to have relatively better improvement among three groups although not significant (P = 0.051). The CFTs of all three groups significantly decreased from baseline (P < 0.0001 in all three groups). The CFT decreased the most in the SRD group, followed by the CME group, and the least in the DRT group (P < 0.001). Conclusion: Anti-VEGF therapy improved the anatomical structure and function in all types of DME; SRD responded the best.

Optical coherence tomography angiography analysis of choroidal microvasculature in various forms of diabetic macular edema

Optical coherence tomography angiography (OCTA) research in diabetic macular edema (DME) has focused on the retinal microvasculature with little attention to the choroid. The goal of this study was to analyze the association between quantitative choroidal OCTA parameters and various forms of DME observed on optical coherence tomography. We conducted a retrospective study of 61 eyes of 53 patients with DME. DME was classified as early or advanced, and as sponge-like diffuse retinal thickening (DRT), cystoid macular edema (CME) or serous retinal detachment (SRD). Quantitative OCTA parameters (vessel density [VD] in the superficial capillary plexus [SCP], middle capillary plexus [MCP], deep capillary plexus [DCP] and choriocapillaris [CC]) were recorded. The VD in the CC and SCP was significantly higher in patients with early DME compared to patients with advanced DME (P value<0.01). CC VD was lower in subjects with SRD compared to DRT and CME (P value<0.001). Moreover, it was lower in CME compared to DRT (P value<0.05). No statistical differences were found between VD in the MCP and DCP (P value>0.05). Furthermore, CC VD was lower in patients with increased retinal thickness, disruption of the ellipsoid zone (EZ) or external limiting membrane (ELM), and disorganization of the inner retinal layers (DRIL) (P value<0.05). CC ischemia plays an important role in the pathogenesis of DME. We demonstrated a decrease in CC VD in patients with severe DME, SRD, retinal thickening, EZ and/or ELM disruption and DRIL.

Macular vascular features of different types of diabetic macular edema using ocular coherence tomography angiography- a comparative study

BackgroundTo compare the microvascular features of different subtypes of diabetic macular edema (DME) by optical coherence tomography angiography (OCTA).MethodsA cross-sectional study including treatment-naive patients with DME. Eyes were divided according to optical coherence tomography determined morphology into two groups: cystoid macular edema (CME) and diffuse retinal thickening (DRT), with further subdivision according to the presence of subretinal fluid. All patients underwent 3 × 3 and 6 × 6 mm OCTA scans of the macula to compare the foveal avascular zone (FAZ) area, vascular density (VD) of the superficial (SCP) and deep (DCP) capillary plexus and choriocapillaris flow (CF). Laboratory findings (HbA1C and triglyceride levels) were also correlated with the OCTA findings.ResultsThe study included 52 eyes, 27 had CME and 25 had DRT. There were no significant differences between the VD of the SCP (p = 0.684) and DCP (p = 0.437), FAZ of SCP (p = 0.574), FAZ of DCP (p = 0.563) and CF (p = 0.311). Linear regression analysis revealed that DME morphology was the strongest predictor for BCVA. Other significant predictors included HbA1C and triglyceride levels.ConclusionThe morphology of DME, irrespective of SRF, was most significantly correlated with BCVA in treatment-naive patients and CME subtype could be an independent predictor of poor BCVA in patients with DME.

A real-world study for timely assessing the diabetic macular edema refractory to intravitreal anti-VEGF treatment.

Early Identifying and characterizing patients with diabetic macular edema (DME) is essential for individualized treatment and outcome optimization. This study aimed to timely investigate optical coherence tomography (OCT) biomarkers of DME refractory to intravitreal anti-vascular endothelial growth factor (VEGF) therapy. We retrospective reviewed 72 eyes from 44 treatment-naïve patients who were treated with intravitreal anti-VEGF for DME. OCT scans prior to anti-VEGF were evaluated for serous retinal detachment (SRD), size of outer nuclear layer cystoid changes, diffuse retinal thickening, integrity of the inner segment-outer segment (IS-OS) junction, quantity and location of hyperreflective foci, vitreomacular interface abnormalities, and epiretinal membrane (ERM). The Baseline best-corrected visual acuity (BCVA) and central macular thickness was recorded at baseline and 4 months after treatment with anti-VEGF. The main outcome measure was the correlation between spectral-domain OCT measurements and BCVA response at baseline and after anti-VEGF treatment (mean change from baseline; ≥ 10 Early Treatment Diabetic Retinopathy Study letters in BCVA). Partially continuous IS-OS layers (partially vs. completely continuous: β, -0.138; Wald chi-square, 16.392; P<0.001) was predictor of better response to anti-VEGF treatment. In contrast, ERM (present vs. absent ERM: β, 0.215; Wald chi-square, 5.921; P=0.015) and vitreomacular traction (vitreomacular traction vs. posterior vitreous detachment: β=0.259; Wald chi-square=5.938; P=0.015) were the predictors of poor response. The improvement of BCVA trended toward the OCT predictive value of central macular thickness reduction; however, this was not significant. Partially continuous IS-OS layers is predictive of better response to anti-VEGF therapy in DME. Meanwhile, ERM is a significant predictor of poor response.

Optical coherence tomography classifications of diabetic macular edema and response to aflibercept: One-year follow-up outcomes in a Chinese population.

To evaluate the effect of intravitreal aflibercept on different classifications of diabetic macular edema (DME) by spectral-domain optical coherence tomography. This hospital-based retrospective study included 95 consecutive patients (130 eyes) diagnosed with DME. Three groups were defined: diffuse retinal thickening (DRT), cystoid macular edema and serous retinal detachment. All eyes received intravitreal aflibercept (0.05 mL/2 mg) 5 times monthly. Best corrected visual acuity (BCVA) in (logarithm of the minimum angle of resolution) units and central macular thickness (CMT) on optical coherence tomography were recorded at months 1, 2, 3, 4, 6, and 12 after the injections. There was no significant baseline difference in BCVA (P = .273) or CMT (P = .115) among the 3 groups. Over 12 months, the BCVA of the DRT group significantly improved from baseline (P = .013). The BCVA of the cystoid macular edema (P = .062) and serous retinal detachment groups (P = .073) improved slightly from baseline. The DRT group had the greatest BCVA improvement (P = .021). Over 12 months, the CMTs of all 3 groups significantly decreased from baseline (P = .016, P = .025, P = .031). The CMT decreased more in the DRT group than in the other 2 groups (P = .009). The CMT changes were most evident in the DRT group (P = .022). Binary logistic regression analysis showed that DME type, disorganization of the retinal inner layers, ellipsoid zone disruption and external limiting membrane disruption independently predicted the effect of aflibercept treatment in DME patients (P = .006, P = .001, P = .004, P = .001). Aflibercept therapy improved anatomical structure and visual acuity in every type of DME; DRT responded best in terms of both BCVA and CMT. Furthermore, DME, disorganization of the retinal inner layers, external limiting membrane disruption and ellipsoid zone disruption independently predicted the effect of aflibercept treatment in DME patients.

Multivendor fully automatic uncertainty management approaches for the intuitive representation of DME fluid accumulations in OCT images

Diabetes represents one of the main causes of blindness in developed countries, caused by fluid accumulations in the retinal layers. The clinical literature defines the different types of diabetic macular edema (DME) as cystoid macular edema (CME), diffuse retinal thickening (DRT), and serous retinal detachment (SRD), each with its own clinical relevance. These fluid accumulations do not present defined borders that facilitate segmentational approaches (specially the DRT type, usually not taken into account by the state of the art for this reason) so a diffuse paradigm is used for its detection and visualization. In this paper, we propose three novel approaches for the representation and characterization of these types of DME. A baseline proposal, using a convolutional neural network as backbone, another based on transfer learning from a general domain, and a third approach exploiting information of regions without a defined label. Overall, our baseline proposal obtained an AUC of 0.9583 ± 0.0093, the approach pretrained with a general-domain dataset an AUC of 0.9603 ± 0.0087, and the approach pretrained in the domain taking advantage of uncertainty, an AUC of 0.9619 ± 0.0073.

Association between Aqueous Humor Cytokines and Structural Characteristics Based on Optical Coherence Tomography in Patients with Diabetic Macular Edema.

To investigate the relationship between aqueous humor cytokines and structural characteristics based on optical coherence tomography (OCT) in patients with diabetic macular edema (DME). Forty eyes of 28 patients with DME diagnosed in the Affiliated Eye Hospital of Wenzhou Medical University at Hangzhou were included. All patients collected aqueous humor during anti-VEGF treatment, and the IL-6, IL-8, IL-10, VEGF, VCAM-1, ICAM-1, TGF-β1, FGF, and MCP-1 concentrations were detected. OCT examination was performed before anti-VEGF treatment and 1 month after anti-VEGF operation. Central macular thickness (CMT), macular volume (MV), choroidal thickness (CT), and the number of hyperreflective foci (HRF) were obtained for analysis. Each eye was determined whether there is subretinal effusion (SRD), cystoid macular edema (CME), and diffuse retinal thickening (DRT). The levels of IL-6 and FGF in DME patients with SRD were significantly higher than those without SRD (all P < 0.05). The level of VEGF in DME patients with CME was significantly higher than that in DME patients without CME (P = 0.005); IL-6, TGF-β1, and MCP-1 were significantly higher in DME patients with DRT than that without DRT (all P < 0.05). There was no significant correlation between aqueous humor cytokines and retinal thickness and retinal volume. However, the thinner the CT, the higher the level of aqueous humor cytokines IL-6 (r = -0.313, P = 0.049) and FGF (r = -0.361, P = 0.022). A multivariate linear regression analysis showed that IL-6 was significantly correlated with CT (P = 0.002) and SRD (P = 0.017), FGF was also significantly correlated with CT (P = 0.002) and SRD (P = 0.005), and TGF-β1 was correlated with triglycerides (P = 0.030) and HRF (P = 0.021). DME patients with significant macular cystoid edema changes may be related to high VEGF concentrations and thin CT; meanwhile, the presence of SRD or a high number of HRF on OCT macular scans in DME patients may indicate high levels of intraocular inflammatory factors. Thus, OCT morphology characteristics to some extent reflect intraocular inflammatory factors and VEGF levels and may guide treatment alternatives.

Disproportionately large neurosensory retinal detachment in diabetic retinopathy as a sign of diabetic choroidopathy

Neurosensory retinal detachment (NSD) is a component of diabetic retinopathy. It is associated with other features like diffuse retinal thickening and cystoid macular edema (CME). The present report describes imaging features and the outcome of disproportionately large NSD in the left eye of a 61-year-old lady having proliferative diabetic retinopathy. The NSD was accompanied by minimal intraretinal edema and a choroidal filling defect on fluorescein angiography. There was near complete resolution of NSD with intravitreal ranibizumab. Disproportionately large NSD with minimal intraretinal cystic changes may be considered as a sign of diabetic choroidopathy.

Effect of Intravitreal Ranibizumab Injection on Different Optical Coherence Tomographic Patterns of Diabetic Macular Edema

Giriş ve Amaç: Spektral-domain optik koherens tomografi (SD-OKT) ile belirlenen farklı paternlerdeki diyabetik maküla ödemi (DMÖ) olgularında intravitreal ranibizumab (İVR) enjeksiyonunun erken dönem etkinliğini karşılaştırmak.&#x0D; Gereç ve Yöntemler: Tek doz İVR uygulanmış nonproliferatif diyabetik retinopatiye sekonder DMÖ olguları retrospektif olarak analiz edildi. Klinik anlamlı santral DMÖ’sü olan ve santral fovea kalınlığı (SFK)≥250 µm olan gözler çalışmaya dahil edildi. Olgular SD-OKT morfolojisine göre; süngerimsi diffüz retina kalınlaşması (DRK), kistoid maküla ödemi (KMÖ) ve seröz retina dekolmanı (SRD) gruplarına ayrıldı. Gruplar enjeksiyon öncesi ve enjeksiyon sonrası birinci ay kontrollerinde, en iyi düzeltilmiş görme keskinliği (EİDGK), SFK ve total maküla volümü (TMV) değişimi açısından karşılaştırıldı. SFK değişimi üzerindeki başlangıç SFK değerlerinin etkisini dışlamak için ANCOVA analizi ve gruplar arasında randomizasyon yapılarak alt analizler yapıldı. &#x0D; Bulgular: Çalışmaya 101 olgu (44 DRK, 40 KMÖ ve 17 SRD) dahil edildi. Gruplar yaş ve cinsiyet dağılımı açısından benzerdi (p&gt;0,05). Başlangıç EİDGK ve TMV değerleri arasında anlamlı fark yok iken (p&gt;0,05), başlangıç SFK değerleri büyükten küçüğe doğru sırası ile SRD, KMÖ ve DRK şeklinde sıralandı (p

A Cross-Sectional Study of Various Imaging and Biochemical Biomarkers in Patients with Diabetic Macular Edema in Different Stages of Diabetic Retinopathy.

PurposeTo compare which imaging and biochemical biomarkers are associated with different stages of diabetic retinopathy (DR) in type 2 diabetes mellitus patients with diabetic macular edema (DME).Patients and MethodsIt was a cross-sectional, observational study that included 100 patients of DME with different stages of DR. Patients were divided into two groups: Group A – DME with non-proliferative diabetic retinopathy (NPDR) and Group B - DME with proliferative diabetic retinopathy (PDR). Group A was further subdivided into three subgroups: A (1) – DME with mild NPDR, A (2) – DME with moderate NPDR, and A (3) – DME with severe NPDR. The primary outcome measure was the association of imaging and biochemical biomarkers with different stages of DR in patients with DME.ResultsOut of 100 patients, Group A (1) had 1, Group A (2) 44, Group A (3) 29, and group: B had 29 patients. As Group A (1) had only one patient, we did not include it in the calculation. The overall mean age of the study population was 54.84+9.87 years, with a male preponderance (76%). The HbA1c levels, serum triglyceride level, serum cholesterol level, and microalbuminuria level showed no significant association with different stages of DR (P>0.05). Still, we found high serum urea levels (p=0.027) in Group B patients. The optical coherence tomography (OCT)-based imaging biomarkers – central subfield thickness (CST), cystoid macular edema (CME), subretinal fluid (SRF), and hyperreflective foci (HRF) – showed no significant association with various stages of DR. The presence of diffuse retinal thickness (DRT) (p=0.04) and the epiretinal membrane (ERM) (p=0.04) showed significant association with Group B patients.ConclusionThe essential biochemical biomarkers such as serum urea levels and DRT and ERM may be considered an important imaging biomarker for the advanced stage of DR.

Change of Optical Coherence Tomography Morphology and Associated Structural Outcome in Diabetic Macular Edema after Ranibizumab Treatment.

(1) Background: To investigate the correlation between therapeutic outcome and morphologic changes for diabetic macular edema (DME) after intravitreal injection of ranibizumab (IVIR). (2) Methods: This retrospective study included 228 eyes received IVIR for DME. Each participant was traced for two years after the initial IVIR, while the data of ophthalmic examination, optical coherence tomography (OCT) image, and systemic diseases were collected. The study population was categorized into different subgroups according to the existence of OCT morphologic change and the initial OCT morphologic pattern, including diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD), and vitreomacular interface abnormalities (VMIAs). The primary outcomes were the baseline best-corrected visual acuity (BCVA) and central macular thickness (CMT) during a two-year study period. The distribution of OCT morphologic change and its relation to primary outcome were analyzed. (3) Results: Comparing the 42 eyes (18.4%) with OCT morphological changes to another 186 eyes (81.6%) without such alteration, the former showed a poorer baseline BCVA (0.84 ± 0.39 vs. 0.71 ± 0.36, p = 0.035), worse final BCVA (0.99 ± 0.44 vs. 0.67 ± 0.30, p = 0.001), and thicker final CMT (354.21 ± 89.02 vs. 305.33 ± 83.05, p = 0.001). Moreover, the VMIA developed in 14.9% of all DME patients presenting the most common morphologic change among DRT, CME, and SRD. Besides, the presence of stroke was independently correlated to the morphologic change (adjusted odds ratio [aOR]: 6.381, 95% confidence interval (CI): 1.112–36.623, p = 0.038). (4) Conclusions: The change of OCT morphology in DME patients receiving IVIR was correlated to worse structural and visual outcome while the formation of VMIA most commonly occurred after initial treatment.

Optical coherence tomography patterns of diabetic macular edema and treatment response to bevacizumab: a short-term study.

Background:The purpose of this study was to evaluate the short-term response of intravitreal bevacizumab in diabetic macular edema (DME) and assess the variation in treatment outcomes in different morphology patterns using spectral domain–optical coherence tomography (SD-OCT).Objective:To study different morphological patterns of DME based on OCT and compare their treatment response to bevacizumab.Methods:Hundred and twelve eyes of 112 patients with DME were included and treated with intravitreal bevacizumab (1.25 mg/0.05 ml monthly for 3 months). The morphological patterns of DME were classified on the basis of OCT into three groups – diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD) – and changes in central macular thickness (CMT) and best corrected visual acuity (BCVA) after treatment were compared.Results:A total of 112 eyes with DME were included and consisted of 40 DRT, 37 CME, and 35 SRD. Treatment with bevacizumab resulted in decrease in central macular thickness and improvement in BCVA in all three groups. The baseline visual acuity and CMT of DRT group was better than that of the other two groups. The treatment outcome was measured in terms of CMT and BCVA. Change in CMT was statistically significant among three groups and was found to be better in DRT group (p < 0.05, 95% confidence interval). However, there was statistically no significant variation between the three groups regarding the change in BCVA (p = 0.169, 95% confidence interval).Conclusion:Anatomic and visual improvement can be achieved by bevacizumab in all patterns of DME. However, individual pattern may respond differently. DRT, which appears to be the earliest form of DME, responds better than other types. Thus, the pattern of macular edema shown by OCT may provide an objective guideline in predicting the response of bevacizumab injection in DME.

Treatment response to Conbercept of different types of diabetic macular edema classified based on optical coherence tomography

To compare different types of diabetic macular edema (DME) classified based on optical coherence tomography (OCT) for their responses to Conbercept injection and analyze the factors that affect the treatment responses. We retrospectively analyzed the clinical data of 65 patients (76 eyes) with DME diagnosed and treated with intravitreal injection of Conbercept (1+PRN) in our hospital from February, 2019 to February, 2021. According to OCT findings, DME in these patients was classified into cystic macular edema (CME; 28 eyes), serous retinal detachment (SRD; 33 eyes), and diffuse retinal thickening (DRT; 15 eyes). The best corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured before and at 3 months after the first treatment. The baseline OCT characteristics of different types of DME were compared, and the correlation of these OCT characteristics with the treatment response to Conbercept was analyzed. All the patients showed significant improvement of the BCVA 3 months after the treatment (P < 0.05). For all the 3 types of DME, the CRT at 3 months after the first treatment was significantly reduced as compared to the baseline (P < 0.05). The number of hyperreflective foci (HF) in the outer retina and the proportion of ellipsoid zone (EZ) interruption were the greatest in SRD group (P < 0.05). The baseline outer retinal HF was significantly correlated with the baseline CRT, CRT changes and CRT after treatment (all P < 0.05). The patients with baseline outer limiting membrane (ELM)/ EZ disruption had poorer baseline BCVA, greater baseline CRT, greater variation of CRT and poorer BCVA at 3 months after treatment (all P < 0.05). For all the 3 types of DME, treatment with intravitreal injection of Conbercept can significantly improve the BCVA and CRT of the patients. DME of the SRD type has the best morphological response to Conbercept, while the DRT type has a relatively poor response. A greater number of HF at baseline may indicate a better morphological response to Conbercept treatment, and baseline ELM/EZ disruption may suggest a poor visual prognosis at 3 months after treatment.

Latent Diabetic Macular Edema in Chinese Diabetic Retinopathy Patients.

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.

Prediction of anti‐VEGF efficacy in diabetic macular oedema using intraocular cytokines and macular optical coherence tomography

In eyes with diabetic macular oedema (DME), aqueous humour (AH) cytokine levels before and after anti-vascular endothelial growth factor (VEGF) treatment were compared and correlated with optical coherence tomography structural parameters. This prospective study included 56 control patients with cataracts and 83 patients with DME manifesting as diffuse retinal thickening (DRT), cystoid macular oedema and serous retinal detachment (SRD). AH samples were obtained before intravitreal injection of anti-VEGF or cataract surgery. VEGF, interleukin (IL)-6, IL-8, IL-10, interferon-inducible protein 10 (IP-10) and monocyte chemotactic protein 1 (MCP-1) levels were measured by multiplex bead assay. AH cytokine levels, central macular thickness (CMT), number of hyper-reflective foci (HF), continuity of external limiting membrane and ellipsoid zone (EZ) and best-corrected visual acuity were evaluated. In SRD, IL-6 and MCP-1 levels and HF were increased (all p < 0.05) compared to DRT. At baseline, the number of HF was correlated with VEGF, IL-6, IL-8, IP-10 and MCP-1 (all p < 0.05). Eyes sensitive to anti-VEGF treatment had high baseline levels of VEGF, MCP-1, HF and many EZ disruptions (all p < 0.05). DME patients with normal VEGF levels but with high levels of IL-8, IP-10 and MCP-1 (all p < 0.05) had little change in CMT after anti-VEGF treatment (p = 0.678). AH concentrations of some inflammatory cytokines in DME were differentially expressed among the three DME morphologies. HF was associated with VEGF and other inflammatory cytokine levels. Multiple HF at baseline predicted a significant decrease in CMT, and eyes with normal VEGF but increased inflammatory cytokines may be insensitive to anti-VEGF treatment.

Subfoveal choroidal thickness changes after intravitreal ranibizumab injections in different patterns of diabetic macular edema using a deep learning-based auto-segmentation.

To evaluate the effect of intravitreal injection of ranibizumab (IVR) on subfoveal choroidal thickness (SFCT) and its relationship with central macular thickness (CMT) and best-corrected visual acuity (BCVA) changes in eyes with center-involving DME (CI-DME) using a deep learning-based auto-segmentation. This prospective interventional case series included 68 eyes of 68 patients with CI-DME naive to treatment. Morphological optical coherence tomography (OCT) findings of DME were classified into three patterns of structural change: (i) diffuse retinal thickening (DRT), (ii) cystoid macular edema (CME), and (iii) serous retinal detachment (SRD). All patients underwent 3+prorenata IVR. The treated eyes underwent BCVA evaluation and OCT scanning at baseline and months 1, 3, and 6 after the first injection. Then, the choroid layer was measured using a deep learning-based auto-segmentation. At baseline, the mean SFCT and CMT for SRD, DRT, and CME groups were 324.68 ± 65.58μm and 624.37 ± 77.92μm, 348.91 ± 45.81μm and 443.5 ± 78.33μm, 361.4 ± 64.62μm, and 536.5 ± 66.02μm, respectively. After anti-VEGF treatment, the SFCT and CMT have decreased by varying degrees. At 3 and 6months of treatment, there were no significant changes among these groups. There was no correlation between baseline SFCT and the resulting BCVA (P = 0.670, P = 0.584). There was also no correlation between changes in SFCT and BCVA, CMT (P = 0.344, P = 0.336). After treating CI-DME with IVR, SFCT and CMT significantly decreased. However, there were no significant changes among the SRD, DRT, and CME groups. Trial registration: ChiCTR, ChiCTR-ROC-17013360. Registered 13 November 2017, http://www.chictr.org.cn/ChiCTR-ROC-17013360 .

Study of optical coherence tomography classification and outcome of intravitreal anti-VEGF injection in diabetic macular edema

Diabetic macular edema is the most common cause of vision loss in diabetes. OCT is a non-invasive and non-contact imaging modality that gives high-resolution images of the retina. OCT helps in early diagnosis of macular edema, to classify diabetic macular edema quantitatively, to decide the treatment option and assessing visual prognosis. Aim of this study was to analyse the different patterns of diabetic macular edema in OCT and to observe the visual outcome of intravitreal anti-VEGF injection. All patients who were attending ophthalmology OPD in Tirunelveli medical college hospital with diabetic macular edema from January 2019 to July 2019 were included in the study. Patients with macular edema other than diabetes, OCT with poor signal strength less than 5 were excluded. Patients were subjected to a detailed history, examination with Slit-lamp biomicroscopy, Fundus examination with +90 D lens, Oct was taken in patients with macular edema. Macular cube, OCT classified type of macular edema, Central macular thickness value, quadrant wise distribution of edema, cube average thickness were measured. The number of Anti-VEGF injections and its effect on various types of macular edema was measured. The most common age group is between 41-50 years, males were more than females. The most common type of macular edema is CME (38.5%). There was a significant reduction in macular edema and improvement in visual acuity between pre and post-injection in Cystoid macular edema and diffuse retinal thickness. OCT is an essential tool for the quantitative assessment of macular edema. It helps in deciding treatment modalities, explaining prognosis to patients and predicting the visual outcome.

Optical Coherence Tomographic Patterns as Predictors of Structural Outcome After Intravitreal Ranibizumab in Diabetic Macula Edema.

Background/ObjectivesThe purpose of this study was to present an association between the treatment response of diabetic macular edema (DME) to intravitreal ranibizumab (IVR) injections and different morphology patterns using spectral domain optical coherence tomography (SD-OCT).Subjects/MethodsThis retrospective study included 216 eyes of 142 subjects who received IVR for DME and were observed for at least 2 years. Medical charts and SD-OCT images of consecutive patients were reviewed at baseline, 1, 3, 6, 12, and 24 months after first IVR treatment. The OCT patterns were characterized as diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD), and vitreomacular interface abnormalities (VMIAs). All patients were classified into four groups based on the OCT findings.ResultsFor a total of 216 eyes, 36 eyes were classified into the DRT group, 76 in the CME group, 42 in the SRD group, and 62 in the VMIA group. There were significant central macula thickness (CMT) improvements in all groups at the 1st month and the 2nd year, except for the DRT group at the 2nd year. Patients with OCT findings of hyperreflective dots (HRDs), metabolic parameters of hyperlipidemia, and coronary artery disease (CAD) had significantly less improvements in CMT at 2-year follow-up (P=0.029, 0.007, <0.001, respectively).ConclusionA trend toward decreased effectiveness after long-term IVR treatment was observed in the DRT group. Consistent IVR treatment could still achieve favorable improvement in the reduction of CMT in 2-year follow-up in the VMIA group. Different OCT patterns in DME may affect the therapeutic role of anti-VEGF agents and predict the structure outcome.

Diabetic Macular Edema Characterization and Visualization Using Optical Coherence Tomography Images

Diabetic Retinopathy and Diabetic Macular Edema (DME) represent one of the main causes of blindness in developed countries. They are characterized by fluid deposits in the retinal layers, causing a progressive vision loss over the time. The clinical literature defines three DME types according to the texture and disposition of the fluid accumulations: Cystoid Macular Edema (CME), Diffuse Retinal Thickening (DRT) and Serous Retinal Detachment (SRD). Detecting each one is essential as, depending on their presence, the expert will decide on the adequate treatment of the pathology. In this work, we propose a robust detection and visualization methodology based on the analysis of independent image regions. We study a complete and heterogeneous library of 375 texture and intensity features in a dataset of 356 labeled images from two of the most used capture devices in the clinical domain: a CIRRUSTM HD-OCT 500 Carl Zeiss Meditec and 179 OCT images from a modular HRA + OCT SPECTRALIS® from Heidelberg Engineering, Inc. We extracted 33,810 samples for each type of DME for the feature analysis and incremental training of four different classifier paradigms. This way, we achieved an 84.04% average accuracy for CME, 78.44% average accuracy for DRT and 95.40% average accuracy for SRD. These models are used to generate an intuitive visualization of the fluid regions. We use an image sampling and voting strategy, resulting in a system capable of detecting and characterizing the three types of DME presenting them in an intuitive and repeatable way.

Joint Diabetic Macular Edema Segmentation and Characterization in OCT Images.

The automatic identification and segmentation of edemas associated with diabetic macular edema (DME) constitutes a crucial ophthalmological issue as they provide useful information for the evaluation of the disease severity. According to clinical knowledge, the DME disorder can be categorized into three main pathological types: serous retinal detachment (SRD), cystoid macular edema (CME), and diffuse retinal thickening (DRT). The implementation of computational systems for their automatic extraction and characterization may help the clinicians in their daily clinical practice, adjusting the diagnosis and therapies and consequently the life quality of the patients. In this context, this paper proposes a fully automatic system for the identification, segmentation and characterization of the three ME types using optical coherence tomography (OCT) images. In the case of SRD and CME edemas, different approaches were implemented adapting graph cuts and active contours for their identification and precise delimitation. In the case of the DRT edemas, given their fuzzy regional appearance that requires a complex extraction process, an exhaustive analysis using a learning strategy was designed, exploiting intensity, texture, and clinical-based information. The different steps of this methodology were validated with a heterogeneous set of 262 OCT images, using the manual labeling provided by an expert clinician. In general terms, the system provided satisfactory results, reaching Dice coefficient scores of 0.8768, 0.7475, and 0.8913 for the segmentation of SRD, CME, and DRT edemas, respectively.