Patterns Of Diabetic Macular Edema Research Articles

Association of Various Optical Coherence Tomographic Patterns of Diabetic Macular Edema With Central Subfield Thickness and Visual Acuity: A Cross-Sectional Observational Study.

Introduction Diabetic macular edema (DME) is the most common and vision-threatening complication in diabetic patients with diabetic retinopathy (DR), especially in those with Type 2 diabetes mellitus. Optical coherence tomography (OCT) is a reliable tool most commonly used for assessing macular morphology and provides quantitative information on the macula. OCT also examines the outer retinal layers, which can predict visual outcomes. Thus, our study aims to identify the association of various OCT-detected DME morphological patterns with central subfield thickness (CST) and visual acuity. Materials and methods This is a cross-sectional observational study of 50 patients with DME detected on OCT who visited the Ophthalmology Department of Saveetha Medical College and Hospitals for a period of six months, from November 2023 to April 2024. A complete ocular examination, including best corrected visual acuity, scored with the logMAR scale, anterior segment examination, and fundus biomicroscopy using 90D and 78D lenses, was performed. Early Treatment of Diabetic Retinopathy Study (ETDRS) grading of DR into mild to very severe non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) was noted. Spectral-domain OCT was used to diagnose DME. The CST was measured, and DME was classified into four patterns: sponge-like retinal swelling (SLRS), cystoid macular edema (CME), subretinal fluid (SRF), and posterior hyaloid traction (PHT). Results In the present study, males represented 60%, and females represented 40%. The mean age of the patients was 58.07 ± 6.80 years, with a mean duration of diabetes of 11.91 ± 5.14 years. Of the 50 patients with 100 eyes, only 60 eyes showed DME on OCT. CME was the most common morphological pattern (37%), while the least common pattern was PHT (10%). No significant association was found between a specific morphological pattern and control of diabetes. The most common pattern observed was SLRS in moderate NPDR, CME in severe NPDR, SRF in very severe NPDR, and PHT in PDR. Very severe NPDR patients showed all patterns of DME, and the PHT pattern was observed only in very severe NPDR and PDR. The highest mean CST was observed in the very severe NPDR stage, and the least was in the moderate NPDR stage. The mean CST was highest in SRF patterns and lowest in SLRS patterns. The best mean visual acuity was observed in the SLRS pattern, while the worst mean visual acuity was observed in the SRF pattern, followed by the PHT pattern. Conclusion Our study highlights the importance of OCT in patients with diabetes, as OCT patterns of DME are critical for predicting visual outcomes in DR. Severe grades of DR are usually associated with SRF and PHT patterns. Since patients with SRF and PHT patterns have the worst visual outcomes, these patients, upon identification, need to be counseled about their poor visual prognosis. Those with less severe DR should be closely monitored and advised on effective diabetes control to prevent progression and protect their vision.

One-Year Functional and Morphological Prognosis After Intravitreal Injection Treatments According to Different Morphological Patterns of Diabetic Macular Edema in Real-Life: MARMASIA Study Group Report No.13

ABSTRACT Purpose To evaluate the responses of different optical coherence tomography (OCT) patterns of diabetic macular edema (DME) to intravitreal injection therapy. Methods In this retrospective, comparative, and multicenter study, patients who had previously untreated DME, who received intravitreal ranibizumab (IVR) or aflibercept (IVA) and/or steroid treatment with the pro re nata (PRN) treatment regimen after a 3-month loading dose, and had a 12-month follow-up in the MARMASIA Study Group were included. Morphological patterns of DME were divided into four groups based on OCT features diffuse/spongious edema (Group 1), cystoid edema (Group 2), diffuse/spongious edema+subretinal fluid (SRF) (Group 3), and cystoid edema+SRF (Group 4). Changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) at months 3, 6, and 12, and the number of injections at month 12 were compared between the DME groups. Results 455 eyes of 299 patients were included in the study. The mean baseline BCVAs [Logarithm of the Minimum Angle of Resolution (logMAR)] in groups 1, 2, 3, and 4 were 0.54 ± 0.24, 0.52 ± 0.25, 0.55 ± 0.23, and 0.57 ± 0.27, respectively. There was no significant difference between the baseline mean BCVAs between the groups (p = .35). The mean BCVAs were significantly improved to 0,47 ± 0,33 in group 1, 0,42 ± 0,33 in group 2, 0,47 ± 0,31 in group 3, and 0,45 ± 0,43 at month 12. There was no significant difference between the groups in terms of BCVA change at month 12 (p = .71). The mean baseline CMTs in groups 1, 2, 3, and 4 were 387,19 ± 128,19, 447,02 ± 132,39, 449,12 ± 109,24, and 544,19 ± 178,61, respectively. At baseline, the mean CMT was significantly higher in Group 4 than in the other groups (p = .000). The mean CMTs were significantly decreased to 325,16 ± 97,55, 334,94 ± 115,99, 324,33 ± 79,20, and 332,08 ± 150,40 in four groups at month 12 respectively (p > .05). The groups had no significant difference in mean CMT at month 12 (p = .835). The change in CMT was significantly higher in Group 4 than in the other groups at month 12 (p = .000). The mean number of intravitreal anti-VEGF injections at month 12 was 4.51 ± 1.57 in Group 1, 4.63 ± 1.54 in Group 2, 4.88 ± 1.38 in Group 3, and 5.07 ± 1.49 in Group 4. The mean number of anti-VEGF injections in Group 1 and Group 2 was significantly lower than in Group 4 (p = 0,014 and p = 0,017). Conclusions In real life, there was no significant difference between the DME groups in terms of visual improvement at month 12. However, better anatomical improvement was achieved in Group 4 than in the other DME groups.

Diabetic Macular Edema Optical Coherence Tomography Biomarkers Detected with EfficientNetV2B1 and ConvNeXt.

(1) Background: Diabetes mellitus (DM) is a growing challenge, both for patients and physicians, in order to control the impact on health and prevent complications. Millions of patients with diabetes require medical attention, which generates problems regarding the limited time for screening but also addressability difficulties for consultation and management. As a result, screening programs for vision-threatening complications due to DM have to be more efficient in the future in order to cope with such a great healthcare burden. Diabetic macular edema (DME) is a severe complication of DM that can be prevented if it is timely screened with the help of optical coherence tomography (OCT) devices. Newly developing state-of-the-art artificial intelligence (AI) algorithms can assist physicians in analyzing large datasets and flag potential risks. By using AI algorithms in order to process OCT images of large populations, the screening capacity and speed can be increased so that patients can be timely treated. This quick response gives the physicians a chance to intervene and prevent disability. (2) Methods: This study evaluated ConvNeXt and EfficientNet architectures in correctly identifying DME patterns on real-life OCT images for screening purposes. (3) Results: Firstly, we obtained models that differentiate between diabetic retinopathy (DR) and healthy scans with an accuracy of 0.98. Secondly, we obtained a model that can indicate the presence of edema, detachment of the subfoveolar neurosensory retina, and hyperreflective foci (HF) without using pixel level annotation. Lastly, we analyzed the extent to which the pretrained weights on natural images "understand" OCT scans. (4) Conclusions: Pretrained networks such as ConvNeXt or EfficientNet correctly identify features relevant to the differentiation between healthy retinas and DR, even though they were pretrained on natural images. Another important aspect of our research is that the differentiation between biomarkers and their localization can be obtained even without pixel-level annotation. The "three biomarkers model" is able to identify obvious subfoveal neurosensory detachments, retinal edema, and hyperreflective foci, as well as very small subfoveal detachments. In conclusion, our study points out the possible usefulness of AI-assisted diagnosis of DME for lowering healthcare costs, increasing the quality of life of patients with diabetes, and reducing the waiting time until an appropriate ophthalmological consultation and treatment can be performed.

Comparative study between fundus fluorescein angiography and optical coherence tomography angiography in evaluation of diabetic maculopathy

Background Diabetic maculopathy is a serious consequence of diabetic retinopathy (DR) that greatly affects the visual acuity. Diabetic macular edema (DME) and diabetic macular ischemia (DMI) are major causes of vision affection in diabetic patients. Purpose The aim of this study was to compare fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) in evaluation of diabetic maculopathy. Patients and methods This comparative cross-sectional study was performed on 87 eyes of 54 patients with type I or type II diabetes, older than 18 years old with any diabetic retinal changes, and 108 eyes of 54 control subjects. An ocular examination was performed as well as color fundus photography, FA, and OCTA. Investigations were done on the same day. FA and OCTA findings were summarized and compared. Results The mean age of the patients was 59.4±8.5 years. OCTA was statistically significantly superior to FA in diagnosing DMI. The foveal avascular zone (FAZ) was ischemic (enlarged) in 74 (85.06%) eyes by OCTA compared with only 46 (52.87%) eyes by FA, with a statistically significant difference (P = 0.001). In addition, OCTA detected microaneurysms significantly more than FA (P = 0.001). The mean FAZ area of the control eyes by OCTA was significantly less than in the ischemic eyes (U = 56.602, P < 0.001), while the superficial capillary plexus (SCP) vascular density (VD) and the deep capillary plexus (DCP) VD in the control eyes was statistically significantly higher than in the ischemic eyes (U = 36.984, P < 0.001, and U = 35.955, P < 0.001, respectively). FA showed diffuse leakage (edema) at the macula as the most common pattern of DME that was detected in 37.9% of the eyes followed by focal macular leakage in 18.4% of the eyes and cystoid leakage in 8% of the eyes while 35.5% of the eyes showed no macular edema. Conclusion OCTA is a cornerstone in DMI diagnosis both qualitatively and quantitatively. In addition, it is essential in evaluating the deep retinal vasculature, while FA is essential in diabetic retinopathy grading and in the diagnosis of DME in a qualitative manner. Both investigations are complementary to each other in diabetic maculopathy evaluation.

Choroidal Thickness Measurements in the Case of Diabetic Macular Edema. Comment on Amjad et al. Choroidal Thickness in Different Patterns of Diabetic Macular Edema. J. Clin. Med. 2022, 11, 6169.

We read with great interest the article by Amjad R. et al. on "Choroidal Thickness in Different Patterns of Diabetic Macular Edema" [...].

Reply to Marino et al. Choroidal Thickness Measurements in the Case of Diabetic Macular Edema. Comment on "Amjad et al. Choroidal Thickness in Different Patterns of Diabetic Macular Edema. J. Clin. Med. 2022, 11, 6169".

We are pleased to see that Marino et al. have written a Comment: "Choroidal Thickness Measurements in the Case of Diabetic Macular Edema" [...].

Prognostic Imaging Biomarkers in Diabetic Macular Edema Eyes Treated with Intravitreal Dexamethasone Implant

The aim was to evaluate predictive value of baseline optical coherence tomography (OCT) and OCT angiography (OCTA) parameters in diabetic macular edema (DME) treated with dexamethasone implant (DEXi). OCT and OCTA parameters were collected: central macular thickness (CMT), vitreomacular abnormalities (VMIAs), intraretinal and subretinal fluid (mixed DME pattern), hyper-reflective foci (HRF), microaneurysms (MAs) reflectivity, ellipsoid zone disruption, suspended scattering particles in motion (SSPiM), perfusion density (PD), vessel length density, and foveal avascular zone. Responders' (RES) and non-responders' (n-RES) eyes were classified considering morphological (CMT reduction ≥ 10%) and functional (BCVA change ≥ 5 ETDRS letters) changes after DEXi. Binary logistic regression OCT, OCTA, and OCT/OCTA-based models were developed. Thirty-four DME eyes were enrolled (18 treatment-naïve). OCT-based model combining DME mixed pattern + MAs + HRF and OCTA-based model combining SSPiM and PD showed the best performance to correctly classify the morphological RES eyes. In the treatment-naïve eyes, VMIAs were included with a perfect fit for n-RES eyes. The presence of DME mixed pattern, a high number of parafoveal HRF, hyper-reflective MAs, SSPiM in the outer nuclear layers, and high PD represent baseline predictive biomarkers for DEXi treatment responsiveness. The application of these models to treatment-naïve patients allowed a good identification of n-RES eyes.

Choroidal Thickness in Different Patterns of Diabetic Macular Edema.

This observational study investigated the changes in choroidal thickness (ChT) in different patterns of diabetic macular edema (DME) based on image processing using enhanced-depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT). Participants with ocular conditions affecting the fundus view, including retinal diseases, were excluded. After observing the patient’s medical record, multicolor fundus photos, thickness maps, and subtypes of DME were diagnosed according to the criteria reported by the Early Treatment Diabetic Retinopathy Study (ETDRS). Edema was classified as focal or diffuse and was subdivided into cystic macular edema (CME), CME with subretinal fluid (CME+), and spongy macular edema (SME). Image processing was performed on the B-scan images from SD-OCT to segment the choroid layer and obtain the choroid thickness. A total of 159 eyes of 81 patients (46 males and 35 females; 57.53 ± 9.78 years of age), and 57 eyes of 30 healthy individuals (age 57.34 ± 8.76 years) were enrolled in this study. Out of 159 eyes, 76 had focal macular edema (FME), 13 exhibited SME, and 51 presented CME. Among those with cystic macular edema, 19 eyes showed subretinal fluid (CME+). The average choroidal thickness in FME, diffuse SME, CME, and CME+ was 216.95 ± 52.94 µm, 243.00 ± 46.34 µm, 221.38 ± 60.78 µm, and 249.63 ± 53.90 µm, respectively. The average choroidal thickness in age-matched controls was 213.88 ± 45.60 µm. Choroidal thickness increases with the severity of edema; choroidal thickness was higher in diffuse macular edema than in FME. However, choroidal thickness increased in cystic macular edema with subretinal fluid (CME+).

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.
 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. 
 Bulgular: Çalışmaya 101 olgu (44 DRK, 40 KMÖ ve 17 SRD) dahil edildi. Gruplar yaş ve cinsiyet dağılımı açısından benzerdi (p>0,05). Başlangıç EİDGK ve TMV değerleri arasında anlamlı fark yok iken (p>0,05), başlangıç SFK değerleri büyükten küçüğe doğru sırası ile SRD, KMÖ ve DRK şeklinde sıralandı (p

A Study to Assess the Pattern of Diabetic Macular Edema Using Optical Coherence Tomography (OCT) and to Evaluate the Relevant Risk Factors

A Study to Assess the Pattern of Diabetic Macular Edema Using Optical Coherence Tomography (OCT) and to Evaluate the Relevant Risk Factors

Correlating the patterns of diabetic macular edema, optical coherence tomography biomarkers and grade of diabetic retinopathy with stage of renal disease.

To correlate optical coherence tomography (OCT)-based morphological patterns of diabetic macular edema (DME), biomarkers and grade of diabetic retinopathy (DR) in patients with various stages of chronic kidney disease (CKD) secondary to diabetes. Multicentric retrospective cross-sectional study was conducted at seven centers across India. Data from medical records of patients with DME and CKD were entered in a common excel sheet across all seven centers. Staging of CKD was based on estimated glomerular filtration rate (eGFR). The most common morphological pattern of DME was cystoid pattern (42%) followed by the mixed pattern (31%). The proportion of different morphological patterns did not significantly vary across various CKD stages (p = 0.836). The presence of external limiting membrane-ellipsoid zone (ELM-EZ) defects (p < 0.001) and foveal sub-field thickness (p = 0.024) showed a direct correlation with the stage of CKD which was statistically significant. The presence of hyperreflective dots (HRD) and disorganization of inner retinal layers (DRIL) showed no significant correlation with the stage of CKD. Sight threatening DR was found to increase from 70% in CKD stage 3 to 82% in stages 4 and 5 of CKD, and this was statistically significant (p = 0.03). Cystoid morphological pattern followed by mixed type was the most common pattern of DME on OCT found in patients suffering from stage 3 to 5 of CKD. However, the morphological patterns of DME did not significantly vary across various CKD stages. ELM-EZ defects may be considered as an important OCT biomarker for advanced stage of CKD.

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.

Temporal variation of optical coherence tomography biomarkers as predictors of anti-VEGF treatment outcomes in diabetic macular edema.

To report a longitudinal analysis of specific optical coherence tomography (OCT) features in eyes with diabetic macular edema (DME) treated with anti-VEGF. A total of 133 eyes of 103 consecutive patients with center-involving DME were included in the study. The eyes were treated between August 2008 and April 2019 with three monthly intravitreal anti-VEGF injections, either with or without prompt or deferred laser, followed by pro re nata (PRN) re-treatment. The following OCT biomarkers were evaluated: subfoveal neuroretinal detachment (SND) (defined as present (SND+) or absent (SND-)), hyperreflective retinal foci (HRF) number (defined as: absent/few(HRF-) or moderate/many (HRF+)), external limiting membrane (ELM) integrity, central macular thickness (CMT), and central retinal thickness (CRT). Changes in SND status and in the number of HRF were evaluated at each DME recurrence throughout the follow-up(FU) period. Mutual correlation among OCT biomarkers and their relationship with visual and anatomic outcomes were assessed both at baseline and over the FU period. The mean FU was 71.2 months (SD 28.4; min. 12-max. 111). At baseline, the prevalence of SRD+ was 27.8% and a high number of HRF were detected in 41.4% of the eyes. A significant reduction in the number of HRF, CMT, CRT, and in the prevalence of SND was recorded in the post-loading phase (p-value <0.0001). In DME recurrences, the presence of SND+ and HRF+ was significantly more frequent in eyes with baseline SND+ and HRF+ compared to eyes presenting baseline SND- and HRF- (p-value <0.0001). No role of SND (p-value: 0.926) and HRF (p-value: 0.281) as baseline predictors of visual and anatomic outcomes was demonstrated, while a worse visual outcome was significantly correlated with a higher incidence of relapsing SND+ (p-value <0.0001) and HRF+ (p-value <0.0028) throughout the FU period. In this study, SND and HRF were frequently present in DME recurrences with the same pattern exhibited at baseline, suggesting that these OCT biomarkers may characterize a specific pattern of DME that repeats over time. Moreover, the results suggested that the persistence and recurrence of SND and HRF may account for a decrease in visual function more than the baseline prevalence of these biomarkers. Further studies are required to confirm these findings.

DETECTION OF MORPHOLOGIC PATTERNS OF DIABETIC MACULAR EDEMA USING A DEEP LEARNING APPROACH BASED ON OPTICAL COHERENCE TOMOGRAPHY IMAGES.

To develop a deep learning (DL) model to detect morphologic patterns of diabetic macular edema (DME) based on optical coherence tomography (OCT) images. In the training set, 12,365 OCT images were extracted from a public data set and an ophthalmic center. A total of 656 OCT images were extracted from another ophthalmic center for external validation. The presence or absence of three OCT patterns of DME, including diffused retinal thickening, cystoid macular edema, and serous retinal detachment, was labeled with 1 or 0, respectively. A DL model was trained to detect three OCT patterns of DME. The occlusion test was applied for the visualization of the DL model. Applying 5-fold cross-validation method in internal validation, the area under the receiver operating characteristic curve for the detection of three OCT patterns (i.e., diffused retinal thickening, cystoid macular edema, and serous retinal detachment) was 0.971, 0.974, and 0.994, respectively, with an accuracy of 93.0%, 95.1%, and 98.8%, respectively, a sensitivity of 93.5%, 94.5%, and 96.7%, respectively, and a specificity of 92.3%, 95.6%, and 99.3%, respectively. In external validation, the area under the receiver operating characteristic curve was 0.970, 0.997, and 0.997, respectively, with an accuracy of 90.2%, 95.4%, and 95.9%, respectively, a sensitivity of 80.1%, 93.4%, and 94.9%, respectively, and a specificity of 97.6%, 97.2%, and 96.5%, respectively. The occlusion test showed that the DL model could successfully identify the pathologic regions most critical for detection. Our DL model demonstrated high accuracy and transparency in the detection of OCT patterns of DME. These results emphasized the potential of artificial intelligence in assisting clinical decision-making processes in patients with DME.

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 .

Современные возможности мультимодальной диагностики диабетического макулярного отека для определения выбора тактики лечения

Diabetes is a severe chronic disease that significantly affects the quality of life of individuals, their families, and society worldwide. Diabetic retinopathy, particularly diabetic macular edema (DME), is the leading cause of blindness and low vision among adults of working age in developed countries and Russia. A recent multimodal approach to diagnose DME resulted in new classifications of this disorder and slightly modified earlier views. The analysis of DME biomarkers allows for selecting management strategies for each patient, prescribing adequate medical treatment, and predicting potential treatment response. This paper aimed to analyze published data and up-to-date diagnostic approaches to DME. These tools provide a correct therapeutic strategy based on the DME pattern. Keywords: diabetic macular edema, optical coherence tomography, anti-VEGF treatment. For citation: Pshenichnov M.V. Current multimodal diagnostic tools for diabetic macular edema to select a management strategy. Russian Journal of Clinical Ophthalmology. 2021;21(4):210–214 (in Russ.). DOI: 10.32364/2311-7729-2021-21-4-210-214.

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.

Efficacy of Intravitreal Dexamethasone Implant in Different Patterns of Diabetic Macular Edema.

PurposeDifferent patterns of diabetic macular edema (DME) suggest different pathogenesis and drug response. We evaluated the outcomes after intravitreal dexamethasone (DEX) implant for DME with or without serous retinal detachment (SRD).MethodsIn this retrospective study, 22 naïve patients (23 eyes) with DME who underwent a single DEX implant were evaluated. Based on the optical coherence tomographic pattern of DME, 12 eyes had a cystoid macular edema pattern (Group 1) and 11 eyes had an SRD pattern (Group 2). The best-corrected visual acuity (BCVA), central retinal thickness (СRТ), central retinal volume (CRV), SRD height (SRDh), and intraocular pressure (IOP) were recorded before and at two and four months after the treatment.ResultsThere were no significant differences between the groups regarding demographic, clinical data and outcomes at baseline. In Group 1, the CRT and CRV significantly decreased at two months (P = 0.002 and P = 0.01, respectively), while the BCVA significantly improved at four months (P = 0.03). In Group 2, the CRT and CRV significantly improved (P 0.01 and P 0.01, respectively) during the follow-up period. At four months, both groups showed a recurrence of DME, Group 1 in particular (two-month CRT reduction, –149 127 µm vs four-month CRT reduction, –72 174 µm; P = 0.04). The mean reduction in CRV was significantly different at four months (Group 1, –0.49 1.7 mm vs Group 2, –1.3 1.3 mm; P = 0.04). In Group 2, the SRDh significantly decreased at two (P = 0.01) and four months (P = 0.01). Four cases with elevated IOP were managed.ConclusionDEX implants were found to be effective in different patterns of DME. The SRD pattern may predict a longer-lasting morphologic efficacy.

Association between the patterns of diabetic macular edema and photoreceptors' response after intravitreal ranibizumab treatment: a spectral-domain optical coherence tomography study.

To analyze photoreceptors' condition after intravitreal ranibizumab treatment according to the pattern of diabetic macular edema (DME) on spectral-domain optical coherence tomography (SD-OCT). Retrospective study includes 58 treatment naïve patients with DME, treated with intravitreal ranibizumab injections and followed up for at least 12months. Patients were classified based on DME morphology on SD-OCT into: diffuse macular edema, cystoid macular edema (CME) and serous retinal detachment with CME (SRD/CME). The DME morphology was analyzed, while quantitative measurement of ellipsoid zone (EZ) defect, as well as qualitative assessment of the condition of external limiting membrane (ELM) and interdigitation zone (IZ) at foveal area, was taken before and after treatment. Before treatment, patients with CME presented worse ELM and IZ condition and greater EZ defect than patients with diffuse macular edema or SRD/CME. After treatment, the restoration of EZ defect and IZ was more evident in patients with CME than in diffuse macular edema or SRD/CME. Patients with DME presented significant photoreceptors' restoration after intravitreal ranibizumab injections at the 12-month follow-up. The improvement in EZ defect size and IZ was dependent on the pattern of DME on SD-OCT.

Optical Coherence Tomography Patterns in Diabetic Macular Edema and Its Impact on Anatomical and Functional Outcome after Intravitreal Injection of Ranibizumab

Background: to report the anatomical and functional outcome based on patterns of optical coherence tomography (OCT) morphology in diabetic macular edema (DME), following treatment with intravitreal ranibizumab (IVR) injection. Aim of the Work: to evaluate the role of OCT in detecting the patterns of DME and its effect on anatomical and functional outcome after IVR injection. Patients and Methods: this study enrolled 30 eyes of patients with DME. These patients were categorized into 3 groups according to OCT finding, group I- 10 eyes with diffuse retinal thickening (DRT), group II- 10 eyes with cystoid macular edema (CME), group III- 01 eyes with neurosensory detachment (NSD). All patients received a three monthly doses of intravitreal ranibizumab. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed before and after the treatment (in the 1st, 3rd and 6th month). Results: at month 6, mean BCVA changed with 0.24 ± 0.057 Decimal (P<0.001),0.23± 0.10 Decimal (P<0.001) and 0.11 ± 0.12 Decimal (P=0.019), respectively, for DRT, CME and NSD groups. Mean CMT decreased by119.80 ± 84.58μm (P=0.002) in DRT group, by83.00 ± 65.98μm (P=0.003) in CME group and by 102.30 ± 110.25 μm (P=0.017) in NSD group. The DRT group was associated with superior BCVA improvement and greater reduction in CMT. Conclusion: we found statistically significant improvement of BCVA and CMT in all groups of DME based on OCT pattern at final follow-up with greater reduction in CMT and superior BCVA improvement in DRT group.