Significant Macular Edema Research Articles

Evidence-based Danish guidelines for screening of diabetic retinopathy.

Diabetic retinopathy (DR) is among the leading causes of visual loss in the working-age population. It is generally accepted that screening of DR is cost-effective and can detect DR before it becomes sight-threatening to allow timely treatment. A group of retinal specialists was formed by the Danish Ophthalmological Society with the aim to formulate contemporary evidence-based guidelines for screening of DR in order to implement these in the Danish screening system. We hereby present evidence for DR-screening regarding (1) classification of DR, (2) examination techniques, (3) screening intervals and (4) automated screening. It is our recommendation that the International Clinical Retinopathy Disease Severity Scale should be used to classify DR. As a minimum, mydriatic two-field disc- and macular-centred images are required. In the case of suspected clinically significant diabetic macular oedema, supplementary optical coherence tomography can increase the diagnostic accuracy. There is solid evidence to support a flexible, individualized screening regimen. In particular, it is possible to prolong screening intervals to 24-48months for patients with no or mild nonproliferative diabetic retinopathy (NPDR), but it is also possible to use extended intervals of 12-24months for patients with moderate NPDR given that these are well-regulated regarding glycaemic control (HbA1c≤53mmol/mol) and blood pressure (≤130/80mmHg). Automated screening of DR is encouraging but is not ready for implementation at present. Danish evidenced-based guidelines for screening of DR support high-quality imaging and allow flexible, individualized screening intervals with a potential for extension to patients with low risk of DR progression.

Prevalence and Associated Risk Factors for Diabetic Retinopathy among in-patients Diagnosed with Diabetes Mellitus: A Retrospective Study Conducted in Nobel Medical College and Teaching Hospital, Biratnagar

Background: Diabetes mellitus (DM) being disease of modern world occurrence of Diabetic retinopathy (DR) has become more frequent. Knowledge on the prevalence and associated risk factors of diabetic retinopathy helps to detect the disease in its early course. The objective of the study was to establish the prevalence and to analyze the associated risk factors and help to screen the disease as early as possible so as to prevent and /or to delay the onset as well as progression of DR. Materials and Methods: A hospital based retrospective study conducted among 213 in-patients of Nobel Medical College, Biratnagar diagnosed with DM. Result: The prevalence of diabetic retinopathy was 32.39% and prevalence of mild NPDR, moderate NPDR, severe NPDR, very severe NPDR, proliferative diabetic retinopathy and clinically significant macular edema was 12.7%, 8.9%, 6.1%, 5%, 1.9% & 2.3% respectively. There was statistically significant relation of diabetic retinopathy with duration of diabetes (p value 0.004) and the mean duration was 8.704 years. Conclusions: The prevalence of diabetic retinopathy among in-patients was 32.39%. Though there was no significant relation with occurrence of DR with type of diabetes, age, sex, alcoholism, smoking and drug intake history, the duration of diabetes and hyperlipidemia, poor hyperglycemic control were highly significantly associated with DR while high BP showed marginally insignificant relation with the same. Journal of Nobel Medical College Volume 7, Number 1, Issue 12, January-June 2018, Page: 50-55

Presence of chronic diabetic foot ulcers is associated with more frequent and more advanced retinopathy.

To clarify the frequency and severity of diabetic retinopathy in a group of people with Type 2 diabetes and chronic diabetic foot ulcers, and to compare visual acuity, levels of retinopathy and clinical significant macular oedema with a matched control group of people with Type 2 diabetes without a history of chronic diabetic foot ulcers. Visual acuity and fundus imaging were evaluated in 90 white people with at least 3 months' duration of full-thickness diabetic foot ulcers below the ankle and the results compared with those in 180 white people with Type 2 diabetes without a history of chronic diabetic foot ulcers (control group). Controls were matched for age, sex and duration of diabetes. Despite similar age and diabetes duration, severe non-proliferative or proliferative diabetic retinopathy was present in 41% of the people in the diabetic foot ulcer group as compared to 15% in the control group (P<0.001). Only 6% in the diabetic foot ulcer group was without any diabetic retinopathy as compared to 34% among controls. Proliferative diabetic retinopathy was more common in the diabetic foot ulcer group (31% vs 8%; P<0.001), but time-to-proliferative diabetic retinopathy did not differ between groups. Clinically significant macular oedema was more frequently present, and the diabetic foot ulcer group exhibited significantly worse results in best and worst eye visual acuity testing. In this northern European setting almost all people with Type 2 diabetes and chronic diabetic foot ulcers had diabetic retinopathy. Almost one-third had proliferative diabetic retinopathy as compared to <10% in our matched control group. More advanced diabetic retinopathy was linked to worse visual acuity.

CHANGES IN CHOROIDAL THICKNESS IN CLINICALLY SIGNIFICANT PSEUDOPHAKIC CYSTOID MACULAR EDEMA.

To investigate choroidal thickness in eyes with clinically significant pseudophakic cystoid macular edema (PCME) during the acute phase and following resolution of the edema, using enhanced depth imaging spectral domain optical coherence tomography (EDI-OCT). This is a retrospective, observational clinical study. Patients' records were reviewed for cases of clinically significant PCME after uneventful phacoemulsification surgery. Choroidal thickness was measured at time of PCME diagnosis in both eyes and after CME resolution in the affected eye using enhanced depth imaging spectral domain optical coherence tomography (Spectralis; Heidelberg Engineering). Measurements were taken subfoveal and 1.5 mm nasal, temporal, inferior, and superior from the center of the fovea. Statistical analysis was performed using paired t-test and Pearson correlation. Mean subfoveal choroidal thickness in 34 eyes with PCME measured 258 ± 83 μm at baseline and decreased to 215 ± 79 μm after CME resolution (P < 0.001). Mean subfoveal choroidal thickness measured at baseline in fellow eyes was significantly lower (194 ± 77 μm) compared to acute PCME (P < 0.001) and after CME resolution (P = 0.011). Choroidal thickness is increased in eyes with PCME and decreases following edema resolution. These findings may strengthen the hypothesis of an inflammatory pathogenesis in PCME.

Retinal images benchmark for the detection of diabetic retinopathy and clinically significant macular edema (CSME).

Diabetes mellitus is an enduring disease related with significant morbidity and mortality. The main pathogenesis behind this disease is its numerous micro- and macrovascular complications. In developing countries, diabetic retinopathy (DR) is one of the major sources of vision impairment in working age population. DR has been classified into two categories: proliferative diabetic retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR). NPDR is further classified into mild, moderate and severe, while PDR is further classified into early PDR, high risk PDR and advanced diabetic eye disease. DR is a disease caused due to high blood glucose levels which result in vision loss or permanent blindness. High-level advancements in the field of bio-medical image processing have speeded up the automated process of disease diagnoses and analysis. Much research has been conducted and computerized systems have been designed to detect and analyze retinal diseases through image processing. Similarly, a number of algorithms have been designed to detect and grade DR by analyzing different symptoms including microaneurysms, soft exudates, hard exudates, cotton wool spots, fibrotic bands, neovascularization on disc (NVD), neovascularization elsewhere (NVE), hemorrhages and tractional bands. The visual examination of the retina is a vital test to diagnose DR-related complications. However, all the DR computer-aided diagnostic systems require a standard dataset for the estimation of their efficiency, performance and accuracy. This research presents a benchmark for the evaluation of computer-based DR diagnostic systems. The existing DR benchmarks are small in size and do not cover all the DR stages and categories. The dataset contains 1445 high-quality fundus photographs of retinal images, acquired over 2 years from the records of the patients who presented to the Department of Ophthalmology, Holy Family Hospital, Rawalpindi. This benchmark provides an evaluation platform for medical image analysis researchers. Furthermore, it provides evaluation data for all the stages of DR.

Clinical Profile of HLA B-27-Associated Uveitis Patients in a Tertiary Care Eye Hospital in Eastern India

ABSTRACTPurpose: To analyse clinical profile of the patients with HLA B 27- associated uveitis in a tertiary care eye hospital in Eastern India Method: Retrospective analysis of 61 eyes of 43 patients with HLA B27- associated uveitis between 2015 and 2016. Result: We observed a male predominance (67%), and more unilateral involvement (58%) in our patients. The mean age of presentation was 44.7 ±11.7 years. Significant vitritis and macular edema were noted in 14 and 7 eyes respectively. In addition to topical therapy, oral steroid was required in 49% patients and 58% patients were treated with methotrexate. Five patients (12%) required biologicals. There was improvement in BCVA at final follow-up (p<0.001). Conclusion: Compared to the existing literature, the current study observed relatively high age of presentation and frequent posterior segment involvement with less systemic association.

Randomized controlled European multicenter trial on the prevention of cystoid macular edema after cataract surgery in diabetics: ESCRS PREMED Study Report 2

To compare the efficacy of perioperative treatment strategies, in addition to topical bromfenac 0.09% and dexamethasone 0.1%, to reduce the risk for developing cystoid macular edema (CME) after uneventful cataract surgery in diabetic patients. Twelve European study centers. Randomized clinical trial. Diabetic patients having phacoemulsification cataract surgery were randomly allocated to receive no additional treatment, a subconjunctival injection with 40mg triamcinolone acetonide, an intravitreal injection with 1.25mg bevacizumab, or a combination of both. The main outcomes were the difference in central subfield mean macular thickness, corrected distance visual acuity, and the incidence of CME and clinically significant macular edema within 6 and 12weeks postoperatively. The study comprised 213 patients. At 6 and 12weeks postoperatively, the central subfield mean macular thickness was 12.3μm and 9.7μm lower, respectively, in patients who received subconjunctival triamcinolone acetonide than patients who did not (P = .007 and P = .014, respectively). No patient who received subconjunctival triamcinolone acetonide developed CME. Intravitreal bevacizumab had no significant effect on macular thickness. Diabetic patients who received a subconjunctival injection with triamcinolone acetonide at the end of cataract surgery had a lower macular thickness and macular volume at 6 and 12weeks postoperatively than patients who did not. Intravitreal bevacizumab had no significant effect.

The Relationship of Retinal Vessel Geometric Characteristics to the Incidence and Progression of Diabetic Retinopathy

To examine the relationships of retinal vessel geometric characteristics (RVGCs) to the incidence and progression of diabetic retinopathy (DR). Observational, prospective cohort study. Nine hundred ninety-six persons with type 1 diabetes mellitus (T1DM) and 1370 persons with type 2 diabetes mellitus (T2DM) seen at a baseline examination who were eligible for follow-up examinations at subsequent 5-year intervals. A total of 3846 person-interval data from these follow-up examinations are the basis for the analyses. Diabetic retinopathy and macular edema were assessed by grading of 30° stereoscopic color fundus photographs. Retinal vessel geometric characteristics were assessed using the Singapore I Vessel Assessment program from a digitized copy of 1 of the field 1 fundus photographs obtained at baseline and follow-up. The 5-year incidence of any DR, progression of DR, and incidence of proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME) in right eyes. Incident DR occurred in 45%, progression in 32%, PDR in 10%, and CSME in 5%. While adjusting for glycated hemoglobin, duration of diabetes, and other factors, retinal arteriolar simple tortuosity was associated significantly with the incidence of any DR (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.01-1.35). Retinal venular branching angle was associated significantly with progression of DR (OR, 1.18; 95% CI, 1.03-1.36), retinal venular curvature tortuosity was associated significantly with the incidence of PDR (OR, 1.15; 95% CI, 1.01-1.30), and retinal venular branching angle (OR, 1.41; 95% CI, 1.10-1.82) was associated significantly with the incidence of CSME. There were no significant associations of other RVGCs with any of the DR outcomes in the full multivariate model. Inclusion of all possible RVGCs did not improve the predictive value of the models that already included retinal vessel diameter and baseline DR severity level. Retinal vessel geometric characteristics of the retinal venules were associated with progression of DR; however, most of the RVGCs measured from digitized fundus photographs added little to the assessment of risk of incidence and progression of DR when other risk factors were considered in T1DM and T2DM.

Non-central diabetic clinical significant macular edema treatment with 532nm sub threshold laser

Non-central diabetic clinical significant macular edema treatment with 532nm sub threshold laser

PATHOPHYSIOLOGICAL REASONING OF THE EFFICIENCY OF ANTI-ANGIOGENIC THERAPY IN THE RETINAL VEIN OCCLUSION BY THE COHERENT EYE TOMOGRAPHY

Aim. The main aim of our research is to study the effectiveness of anti-VEGF therapy in the treatment of retinal vein occlusions. Materials and methods . The study included 124 patients aged between 23 to 66, an average of 54.3±8.9 years old who were on an outpatient and inpatient treatment in the ophthalmologic department of the V.K. Gusak Institute of Emergency and Reconstructive Surgery from 2011 to 2016. We have formed two groups. The comparison group included 66 patients who received standard therapy in the form of local anticoagulant and anti-edematous therapy, disaggregants. To improve microcirculation and with a decongestant purpose, rheopolyglucin was administered intravenously, and intramuscular injections of actovegin were prescribed with an antihypoxic purpose. With edema of the macula and the development of newly formed vessels – laser coagulation, intravitreal or subtenon introduction of trimacionolone. The main group included 58 patients who, in addition to standard therapy, were given the drug Eilia (aflibercept) intravitreally 2 mg in 0.05 ml. Treatment with aflibercept for intravitreal injections started with one injection once a month for the next five months, with a further transition to one injection every two months, with no monitoring required between the injections. Results . When post-thrombotic neovascular glaucoma occurred, the concentration of TGFα in the lacrimal fluid increased by 1.7, and TGFβ by 28-fold. When the branch of the central vein of the retina is occluded according to the ischemic type, the systolic and diastolic blood flow velocity in the retina decreases. With coherent optical tomography with the function of angiography, admission in both groups showed significant macular edema, non-perfusion zones of the retina, a decrease in the density of the capillary network in the inner layers of the retina in angio-OCT, and 3 patients with angio-OCT visualized newly formed vessels in the nonperfusion zone. Conclusion . In the group with the use of anti-angiogenic drugs, earlier restoration of the visual fields and reduction of neoangiogenesis were noted.

Predictive Value of OCT-Controlled Early Response of Macular Edema Secondary to Retinal Vein Occlusion After Intravitreal Bevacizumab Therapy

The goal of this study was to examine the response of macular edema (ME) secondary to retinal vein occlusion (RVO) to predict macular edema course and re-injection intervals. Twenty-four eyes from 24 patients with ME secondary to RVO, both central (CRVO) and branch (BRVO), were retrospectively included. All eyes received intravitreal bevacizumab therapy (1.25 mg/0.1 ml). Repetitive optical coherence tomography (OCT) examinations were performed to document the early macular edema response to treatment and the course of the disease during the first three monthly injections until the last follow-up 105 days after the first injection. A significant ME reduction is present as early as three hours after the first injection of bevacizumab. This significant reduction of central retinal thickness (CRT) is present until the third post-injection day. The greatest reduction occurs during the first 24 hours. Patients who reach a CRT less than 300 µm after 24 hours (day 1) have no recurrence after 30 days. Patients with a CRT over 300 µm on day 1 have a 50% rate of recurrence after 30 days. The favorable results of the first group are still present during the last follow-up examination, 105 days after the first injection. An OCT examination, 24 hours after the first bevacizumab injection, has a prognostic value and can identify the patients that can tolerate longer intervals between injections, this results in fewer bevacizumab injections during the course of the disease. This way an individualization of the treatment, opposed to a fixed therapy pattern, can be implemented. Also, patients with poor prognosis can be identified early and treatment can be altered or intensified accordingly.

European multicenter trial of the prevention of cystoid macular edema after cataract surgery in nondiabetics: ESCRS PREMED study report 1

To compare the efficacy of a topical nonsteroidal antiinflammatory drug, topical corticosteroid, and a combination of both drugs to prevent the occurrence of cystoid macular edema (CME) after cataract surgery in nondiabetic patients. Twelve European study centers. Randomized clinical trial. Nondiabetic patients having uneventful cataract surgery were included in this study. Patients were randomized to receive topical bromfenac 0.09% twice daily for 2weeks or dexamethasone 0.1% 4 times daily with 1 drop less per day every following week, or a combination of both. The primary outcome was the difference in central subfield mean macular thickness 6weeks postoperatively. Secondary outcome measures included corrected distance visual acuity as well as the incidence of CME and clinically significant macular edema (CSME) within 6weeks and 12weeks postoperatively. This study comprised 914 patients. Six weeks postoperatively, the central subfield mean macular thickness was 288.3μm, 296.0μm, and 284.5μm in the bromfenac group, dexamethasone group, and combination treatment group, respectively (overall P=.006). The incidence of clinically significant macular edema within 12weeks postoperatively was 3.6%, 5.1%, and 1.5%, respectively (overall P=.043). Patients treated with a combination of topical bromfenac 0.09% and dexamethasone 0.1% had a lower risk for developing CSME after cataract surgery than patients treated with a single drug.

Impact of Incidence and Progression of Diabetic Retinopathy on Vision-Specific Functioning

To investigate the independent impact of the incidence and progression of diabetic retinopathy (DR) on visual functioning (VF). Population-based cohort study. A total of 518 participants aged 40 to 80 years (baseline visit 2007-2009 and second visit 6 years later, 2013-2015), with diabetes, clinical data, and VF information at both visits. VF-7 scores, converted to interval-level person measures (in logits) using Rasch analysis. Incident DR was defined using the Modified Airlie House classification as "none or minimal" DR at baseline and at least mild nonproliferative DR at follow-up; incident vision-threatening DR (VTDR; severe nonproliferative DR, proliferative DR, and/or clinically significant macular edema) as no VTDR at baseline, and present at follow-up; and DR progression as at least a 1-step worsening in DR at follow-up from mild or worse status at baseline. The longitudinal associations between incident DR, VTDR, and DR progression, as well as change in composite and individual item scores of VF, were assessed using multivariable linear regression models. Of the 518 participants (mean age ± standard deviation [SD] 59.8±9.0 years; 47.7% female), 42 (9.8%), 14 (2.8%), and 32 (42.7%) had incident DR, incident VTDR, and DR progression, respectively, at follow-up. In models adjusting for traditional confounders, persons with incident DR and VTDR had a 13.7% (β=-0.60; 95% confidence interval [CI],-0.96 to -0.24; P= 0.001) and 23% (β=-1.00; 95% CI,-1.61 to-0.38; P= 0.001) reduction in mean VF scores at follow-up. Furthermore, individuals with incident DR had similar independent reductions in scores for 7 individual items of the VF-7, whereas those with incident VTDR had the largest reductions for activities like cooking (31%; P= 0.003), reading the newspaper (29.6%; P < 0.001), and seeing street signs (28%, P= 0.001) at follow-up. Progression of DR was not independently associated with change in overall VF (β=-0.18; 95% CI,-1.00, 0.64; P= 0.660). Incident DR, particularly vision-threatening stages, has a substantial negative impact on people's overall vision-dependent functioning and specific activities such as cooking, seeing street signs, and reading the newspaper. Our findings reinforce the need for strategies to prevent or delay the development of DR.

Diabetic retinopathy in a remote Indigenous primary healthcare population: a Central Australian diabetic retinopathy screening study in the Telehealth Eye and Associated Medical Services Network project.

To determine diabetic retinopathy prevalence and severity among remote Indigenous Australians. A cross-sectional diabetic retinopathy screening study of Indigenous adults with Type 2 diabetes was conducted by locally trained non-ophthalmic retinal imagers in a remote Aboriginal community-controlled primary healthcare clinic in Central Australia and certified non-ophthalmic graders in a retinal grading centre in Melbourne, Australia. The main outcome measure was prevalence of any diabetic retinopathy and sight-threatening diabetic retinopathy. Among 301 participants (33% male), gradable image rates were 78.7% (n = 237) for diabetic retinopathy and 83.1% (n = 250) for diabetic macular oedema, and 77.7% (n = 234) were gradable for both diabetic retinopathy and diabetic macular oedema. For the gradable subset, the median (range) age was 48 (19-86) years and known diabetes duration 9.0 (0-24) years. The prevalence of diabetic retinopathy was 47% (n = 110) and for diabetic macular oedema it was 14.4% (n = 36). In the fully gradable imaging studies, sight-threatening diabetic retinopathy prevalence was 16.2% (n = 38): 14.1% (n = 33) for clinically significant macular oedema, 1.3% (n = 3) for proliferative diabetic retinopathy and 0.9% (n = 2) for both. Sight-threatening diabetic retinopathy had been treated in 78% of detected cases. A novel telemedicine diabetic retinopathy screening service detected a higher prevalence of 'any' diabetic retinopathy and sight-threatening diabetic retinopathy in a remote primary care setting than reported in earlier surveys among Indigenous and non-Indigenous populations. Whether the observed high prevalence of diabetic retinopathy was attributable to greater detection, increasing diabetic retinopathy prevalence, local factors, or a combination of these requires further investigation and, potentially, specific primary care guidelines for diabetic retinopathy management in remote Australia. Clinical Trials registration number: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN 12616000370404.

Visually Significant Cystoid Macula Edema After Glaucoma Drainage Implant Surgery.

This study examines the incidence of visually significant cystoid macular edema (CME) after glaucoma drainage implant (GDI) surgery and analyses risk factors associated with developing CME and prognosis with treatment. In total, 185 eyes from 185 glaucoma patients (mean age, 72.46±13.94 y) who underwent GDI surgery at a tertiary eye institute were recruited. Patients were classified based on the presence (CME) or absence (No-CME) of CME. Pre-GDI and post-GDI best-corrected visual acuity, number of intraocular pressure (IOP)-lowering medications, IOP, standard automated perimetry and post-GDI complications, were recorded and compared between the 2 groups. Optical coherence tomography (OCT) was used to quantify retinal thickness and monitor CME. In total, 41 (22.2%) eyes developed visually significant CME after GDI surgery. Patients with CME had a higher incidence of pre-GDI nonsteroidal anti-inflammatory drug (P<0.01) use and higher number of prior glaucoma surgeries (P<0.01). CME patients had a higher (P<0.01) incidence of iritis, epiretinal membrane, and hypotony. CME eyes responded well to steroids, with resolving macular edema (458.4±151.9 vs. 322.0±92.0 µm, P<0.01) and improving visual acuity (0.73±0.48 vs. 0.56±0.56 logarithm of minimum angle of resolution, P<0.01). Both CME and non-CME groups had equivalent lowering of IOP and post-GDI glaucoma medications; with no significant elevation in IOP in the steroid-treated CME group. Post-GDI surgery visually significant CME rates are potentially higher in a real hospital scenario compared with controlled clinical trials. With diligent treatment, CME resolves effectively restoring visual acuity and central macular thickness.

Anti-inflammatory medication following cataract surgery: a randomized trial between preservative-free dexamethasone, diclofenac and their combination.

To examine the anti-inflammatory efficacy and tolerance between preservative-free dexamethasone (DEX) and diclofenac (DICL) eye drops, and their combination following cataract surgery. A randomized, double-blind, prospective single-centre study with 189 eyes of 180 patients undergoing routine cataract surgery. Laser flare meter measurement and spectral-domain optical coherence tomography imaging were conducted before surgery and at the 28-day postoperative visit. Clinical characteristics, surgical parameters and assessment of postoperative symptoms were recorded. Preoperative flare was 9.0±0.6pu/ms and central retinal thickness (CRT) 269.6±1.9μm (mean±SEM). On day 28, flare was 22.1±2.9 pu/ms for DEX, 17.4±2.5pu/ms for DICL and 13.0±1.6pu/ms (p<0.05) for their combination. Central retinal thickness (CRT) increase was 31.5±8.8μm for DEX, 6.0±0.8μm (p=0.001) for DICL, and 3.5±0.5μm (p<0.001) for their combination. The incidence of ocular symptoms related to the eye drops was 11% for DEX, 37% for DICL and 34% for their combination (p<0.001). Clinically significant pseudophakic cystoid macular oedema (PCME) was observed in seven eyes which were all treated with DEX (p<0.001). Diclofenac (DICL), as well as the combination of DEX and DICL, were superior to DEX monotherapy in minimizing CRT change and the incidence of PCME. Combination medication showed no added value compared to DICL monotherapy in uneventful cataract surgery.

Choroidal vascularity index in type-2 diabetes analyzed by swept-source optical coherence tomography

The relationships between changes in choroidal vasculature and the severity of diabetic retinopathy (DR) remain unclear. We assessed choroidal changes in diabetic patients by measuring choroidal vascularity index (CVI) in conjunction with DR stage. In this study, patients with diabetes and healthy controls were retrospectively analyzed. Subjects were divided into seven groups as follows: Healthy controls, no DR, mild/moderate non-proliferative DR (NPDR), severe NPDR, proliferative DR (PDR), panretinal photocoagulation-treated DR, and clinically significant macular edema. The mean CVI values in the above groups were 69.08, 67.07, 66.28, 66.20, 63.48, 65.38, and 66.28, respectively. The eyes of diabetic patients exhibited a significantly lower CVI value than those of healthy controls even without DR. The PDR group exhibited a significantly lower CVI value than the healthy control, no DR, and mild/moderate NPDR groups. Age, sex, disease duration, glycated hemoglobin, fasting blood sugar, or intraocular pressure had no correlation with CVI. In multivariate regression analysis, thicker subfoveal choroid and thinner central retina were significantly associated with higher CVI values. These findings carefully suggest that changes in choroidal vasculature could be the primary event in diabetes even where there is no DR.

Quantitative Analysis of Macular Thickness following Open Globe Injury in Subjects with Clear Media and no Retinal Damage.

Purpose:To evaluate the change in macular thickness after open globe injury (OGI) in patients with clear media and without retinal damage using optical coherence tomography (OCT).Methods:In this longitudinal observational pilot study, 17 patients with clear media and without retinal damage who underwent repair of OGI for corneal, corneoscleral, or scleral laceration were studied. In addition to routine follow-up, all patients were examined at the first and third postoperative months and best corrected visual acuity (BCVA), slit-lamp examination, applanation tonometry, dilated fundus examinations, and macular OCT scans were documented.Results:In all patients, no signs of macular edema, macular thickening, cystic changes, or other signs of cystoid macular edema were present in OCT images and examinations. The Early Treatment Diabetic Retinopathy Study map indicated that there were no significant differences in macular thickness between the first and third months in all patients (P > 0.05). There was no significant relationship between macular thickness and uveal or vitreous prolapse and the size or site of laceration (P > 0.05). BCVA in the first and third months also showed no significant change (P > 0.05). There were no cases of intraocular pressure increase in any of the patients.Conclusion:Macular thickness had no significant change following OGI repair in eyes with clear media and without retinal damage; thus, it seems that OGI of this extent and its surgical repair have no effect on macular thickness.

Fundus Images-Based Detection and Grading of Macular Edema Using Robust Macula Localization

The macula is an oval-shaped area near the center of the human retina, and at its center, there is a small pit known as the fovea. The fovea contains large concentrations of cone cells and is responsible for sharp, colored vision. Macular disorders are the group of diseases that damage the macula, resulting in blurred vision or even blindness. Macular edema (ME), one of the most common types of macular disorder, is caused by fluid accumulation beneath the macula. In this paper, we present an automated system for the detection of ME from fundus images. We introduce a new automated system for the detailed grading of the severity of disease using knowledge of exudates and maculae. A new set of features is used along with a minimum distance classifier for accurate localization of the fovea, which is important for the grading of ME. The proposed system uses different hybrid features and support vector machines for segmentation of exudates. The detailed grading of ME—as both clinically significant ME and non-clinically significant ME—is done using localized foveae and segmented exudates. The proposed algorithm is validated using public and local data sets. We have achieved an average accuracy of 96.1% in the detection and grading of ME with our proposed method.

Structure Tensor Graph Searches Based Fully Automated Grading and 3D Profiling of Maculopathy From Retinal OCT Images

Maculopathy is a collective group of diseases that damages the central region of a retina known as macula. The major two forms of maculopathy are macular edema (ME) and central serous chorioretinopathy (CSCR). Different researchers have worked on the identification of these macular disorders using optical coherence tomography (OCT) images. However, to the best of our knowledge, no research is reported until now that can automatically extract retinal information for the grading of ME and CSCR as per clinically significant ME (CSME), non-clinically significant ME (non-CSME), Type-I CSCR, and Type-II CSCR clinical standards from OCT images. Therefore, this paper presents a novel structure tensor graph searches (ST-GS)-based segmentation framework that combines a structure tensor and graph theory to automatically extract retinal and choroidal layers along with fluid pores followed by automated reconstruction of 3-D retinal surfaces. The ST-GS can extract retinal information even from highly degraded OCT scans. Furthermore, the proposed system automatically grades ME and CSCR pathologies as CSME and non-CSME and Type-I CSCR and Type-II CSCR, respectively. The proposed system extracts seven distinct features, and it is trained on 30 (10 healthy, 10 ME, and 10 CSCR) labeled OCT volumes containing 3840 brightness scans (B-scans). After that, 90 (30 healthy, 30 CSCR, and 30 ME) unlabeled OCT volumes containing 11520 B-scans were used for testing the proposed system, where it correctly classified 88 out of 90 cases with the sensitivity, specificity, and accuracy ratings of 96.77%, 100%, and 97.78%, respectively. Furthermore, the proposed system has achieved a mean dice coefficient of 0.875±0.0342 and 0.92±0.0258 for extracting cyst and serous fluids, respectively.